Foreign travel and hookworm-related cutaneous larva migrans

Abstract

Funding sources: none. Conflicts of interest: none declared. Dear Editor, We read with interest the article of Vanhaecke et al.1 The authors delineate the causes of 78 cases of ‘creeping eruption’ presenting to a French tropical diseases referral centre. All of the 74 cases of hookworm‐related cutaneous larva migrans (HrCLM) had a history of recent foreign travel and all but one of these had returned from a tropical destination. The 44 cases of HrCLM reported by Blackwell and Vega‐Lopez from the Hospital for Tropical Diseases in London were all acquired outside of Europe, although the authors note that the condition is ‘most prevalent in the tropics [but] also occurs in temperate climates, including the U.K’.2 We wish to emphasize that the lack of a history of foreign travel does not preclude the diagnosis of HrCLM in the U.K. and other parts of northern Europe. A 39‐year‐old woman was referred to our dermatology department for assessment of a pigmented lesion on her left arm. A clinical diagnosis of melanoma was made and subsequently confirmed following complete excision of the lesion. A 3‐cm‐diameter erythematous, scaly plaque with occasional pustules and a serpiginous edge (Fig. 1) was noted on the lateral aspect of the dorsum of the left foot as an incidental finding during the initial consultation. On direct questioning the patient admitted that the plaque was itchy and had been present for 6 months. She was a dog owner and denied any foreign travel for the previous 4 years. A clinical diagnosis of HrCLM was made and the patient was treated with a single dose of oral ivermectin (200 μg kg−1), which led to complete resolution of the rash. Our patient is likely to have acquired the infestation through contact with the soil in her garden into which hookworm ova were excreted by her dog.