Chronic hookworm-related cutaneous larva migrans

Abstract

The purpose of this study is to present the 'chronic' or 'persistent' form of hookworm-related cutaneous larva migrans. From 1998 to 2011, 13 patients were seen in our department with clinically typical hookworm-related cutaneous larva migrans that had been present for more than 5 months and that, because of the absence of pruritus, had never been treated. The duration of hookworm-related cutaneous larva migrans ranged from 5 to 14 months (mean 7.8 months) in these 13 patients (10 males and three females, aged 23-55 years). The infestation was acquired in Brazil (three patients), Jamaica (three patients), Mexico (two patients), Tanzania (two patients), Thailand (two patients), and Martinique (one patient). The infestation was located on the feet in 10 patients; one of these patients also presented tracks on the back and another presented tracks on a knee. The chest (two patients) and thigh (two patients) were also involved. All patients presented with clinically typical hookworm-related cutaneous larva migrans: seven patients had one track and six patients had two tracks. Laboratory and instrumental examinations were within the normal range or negative. Histopathological examination revealed edema in the papillary and upper dermis, and a perivascular and perifollicular infiltrate in the upper dermis, consisting mainly of lymphocytes and eosinophils. No larvae were detected. This can be considered the 'chronic' or 'persistent' form of hookworm-related cutaneous larva migrans. Some pathogenetic hypotheses are suggested.