Ms. Alvarez, a 58 year-old Hispanic woman, presented with 2 years of “infestation with bugs.” The episodes started when she stayed at her friend’s house and was reportedly exposed to dirty blankets and soiled linens. She had seen many physicians, both dermatologists and non-dermatologists. She brought in a bag full of topical medications including topical steroids, anti-fungal creams, anti-bacterial ointments, and moisturizers, none of which were of benefit. She had been treated twice with permethrine (Elimite®) by a dermatologist with only transient relief of symptoms. She described in great details the life cycle and the mating habits of these parasites. She also presented to you zip-lock bags of soiled materials containing tissue papers with brown stains suspended in cloudy water. She stated unequivocally that these specimens contain the “parasites” she has described.