The patient is an active outdoorsy type 64 year old male c/o "itching around my belly button".
Positive for a past history of insect bites in the axillary, ankle, and waistband areas, this patient did not immediately seek treatment until noticing a small umbilical protrusion.
Initial belief was an umbilical hernia, yet no sensation was felt when the protrusion was clamped with a hemostat. Gentle retraction on hemostat allowed the movement of the protrusion which revealed a 0.5 cm Dermacentor variabilis. Further probing located a smaller 0.25 cm arachnid deeper inside the umbilicus.
The area was cleansed with isopropyl alcohol and TAO applied. Patient tolerated the procedure well, stating, "I think I might enter this in allnurses' "Gross Me Out" Contest!"
