A 60-year-old white male, who came from a rehabilitationassisted living facility in Miami, Florida, presented with multiple intensely pruritic migratory erythematous serpiginous tracks for 10 days over his left calf, left anterior leg, and right thigh. There were also hyper-pigmented macules around the tracks with overlying crust (Figure 1). Patient stated that he had been living some time in a bush and sleeping on the ground where stray animals defecate. He was previously treated for scabies with permethrin without success, otherwise unremarkable medical history. Based upon the typical characteristics of the lesions and epidemiologic history, a diagnosis of HrCLM was suspected, but due to the unusual multiple lesions, skin punch biopsies were performed from the left buttock and right posterior lower leg. Histologic sections showed several small intraepidermal cavities, likely corresponding to larva tracks (Figure 2A) associated with eosinophil-rich dermal mixed inflammatory cell infiltrates (Figures 2B and 2C). Histology failed to demonstrate larvae itself. However, given the characteristic clinical presentation and overall histological features, the diagnosis of HrCLM was made.