Cutaneous Larva Migrans

Keywords

Larva migrans; Serpentine rash

Abstract

A 61-year-old previously healthy male presented to an emergency department with a pruritic rash on his left first toe after returning from a vacation that included a visit to Miami, Florida. He recalled walking barefoot during his time there.

The Case

A 61-year-old previously healthy male presented to an emergency department with a pruritic rash on his left first toe after returning from a vacation that included a visit to Miami, Florida. He recalled walking barefoot during his time there. The physician initially diagnosed non-specific blistering and recommended diphenhydramine and watchful waiting. On a repeat visit the rash was noted by the patient to have spread (Figure 1). The definitive diagnosis was made and treatment started.

Figure 1: Close-up pictures of linear eruption on the left first toe.

Diagnosis

Cutaneous Larva Migrans (CLM) is a reaction to the larvae of various Ancylostoma (nematode) species found most commonly in the tropical and subtropical areas of the United States. The nematode has a predilection for warm, moist, sandy soil and is most commonly contracted from walking barefoot on a beach [1]. In the natural host (usually the cat or the dog) the larva migrates to the lungs. In accidental human infections it is not able to penetrate the basal membrane of human skin and is thus confined to the epidermis in a benign, self-limited reaction.

Clinically CLM is characterized by lower extremity creeping serpiginous and erythematous tunnels of 2-3 mm width that track 3-4 cm from the site of penetrations and advance daily by 1-2 cm. The inoculation period is usually 1-5 days but can last as long as 1 month. Clinical history is paramount in providing diagnosis. Once the diagnosis is made, albendazole treatment typically leads to reductions in pruritus within 48 hours and resolution within a week [2]. The best treatment option is prevention in the natural hosts: dogs and cats [3].

References

1. Feldmeier H, Schuster A. Mini review: hookworm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis. 2012; 31: 915–918.

2. Rizzitelli G, Scarabelli G, Veraldi S. Albendazole: a new therapeutic regimen in cutaneous larva migrans. Int J Dermatol. 1997; 36: 700–703.

3. Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis. 2008; 8: 302–309.

Citation

Tavangarian K and Aycock RD. Cutaneous Larva Migrans. SM Emerg Med Crit Care. 2017; 1(1): 1003.