Does cutaneous larva migrans occur only among travelers?

Abstract

Cutaneous larva migrans (CLM) is an infectious disease caused by hookworm larvae. It is characterized by the presence of creeping skin lesions due to the formation of tortuous tubules with inflammatory reactions. CLM is most commonly transmitted by animal feces depositing eggs in the soil, with larvae entering humans through direct contact with skin. A 64-year-old man was admitted to the Dermatology Department to diagnose and treat the one-month history of skin lesions over the skin of the left lower limb. Initially, a small papule appeared, which was indolent, itchy, and fast-growing. The patient denied recent international travel and was diagnosed with eczema cruris with secondary bacterial infection and treated with no improvement. On admission, papular lesions with tunnels and serpiginous erythema on the left limb with accompanying intense pruritus were noted. Laboratory studies revealed anemia and hematocyturia. Based on the clinical picture cutaneous larva migrans were diagnosed. Systemic treatment with mebendazole and topical treatment resulted in fast clinical improvement. Although cutaneous larva migrans is usually endemic, due to the increasing frequency of foreign travels, the disease prevalence rises. Most of the cases are initially underdiagnosed, which results in a delay in proper treatment. Therefore, pruritic lesions, and especially showing no improvement after treatment with corticosteroids and antihistamines, parasitic etiology should always be considered.