Abstract
Introduction: Cutaneous larva migrans (CLM) is a syndrome, defined by clinical appearance of slowly migrating cutaneous eruption caused by inoculation with animal hookworms larvae in the skin. Despite the typical clinical presentation, CLM is frequently misdiagnosed due to its rarity in temperate climate urban communities. Case Report: We report a case of a 42-year old female, admitted to an outpatient clinic with eruption of multiple intense pruritic, erythematous, exudative papules and oval plaques, located predominately on the back. The patient claimed that skin lesions started three weeks before the examination, during her vacation in Thailand, and at first, was taught to be caused by a contact with jelly fish. Lesions were treated unsuccessfully with oral antihistamines and various topical corticosteroids, which lead to more questions regarding the differential diagnosis. Dermoscopical and histopathological findings were indicative of parasitic infection, most likely CLM. A three-day course of oral albendazole, 400 mg daily, resulted in complete cure of the disease. Conclusions: Careful clinical examination and detailed history taken from the patient are fundamentals for creating a set of differential diagnoses, that can be further clarified by the use of laboratory findings, imaging methods (including dermoscopy) and biopsy with histopathology. Although CLM has a benign self-limiting course, intense itch may substantially impact the quality of life, and possible visceral involvement or concomitant parasitic infection may lead to serious health deterioration in unrecognized cases.
Highlights
Cutaneous larva migrans (CLM) is a syndrome, defined by clinical appearance of erythematous, serpiginous, pruritic and slowly migrating cutaneous eruption caused by animal hookworms larvae
Treatment with oral antihistamines and various topical corticosteroids was unsuccessful, which lead to more questions regarding the differential diagnosis
In high-income countries CLM is usually reported in tourists visiting endemic regions, but there are sporadic cases of autochthonous hookworm-related CLM acquired in temperate climate European countries such as Germany, France, UK, Serbia [2,6,7]
Summary
Cutaneous larva migrans (CLM) is a syndrome, defined by clinical appearance of slowly migrating cutaneous eruption caused by inoculation with animal hookworms larvae in the skin. The patient claimed that skin lesions started three weeks before the examination, during her vacation in Thailand, and at first, was taught to be caused by a contact with jelly fish. Lesions were treated unsuccessfully with oral antihistamines and various topical corticosteroids, which lead to more questions regarding the differential diagnosis. Dermoscopical and histopathological findings were indicative of parasitic infection, most likely CLM. Conclusions: Careful clinical examination and detailed history taken from the patient are fundamentals for creating a set of differential diagnoses, that can be further clarified by the use of laboratory findings, imaging methods (including dermoscopy) and biopsy with histopathology. CLM has a benign self-limiting course, intense itch may substantially impact the quality of life, and possible visceral involvement or concomitant parasitic infection may lead to serious health deterioration in unrecognized cases
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