Images in Emergency Medicine

Article Outline

• Diagnosis
  • Cutaneous larvae migrans
• References
• Copyright

A 36-year-old male emergency physician presented 1 week after returning from a medical outreach trip in Guyana (Figure). Although mostly working in a clinical setting with wooden floors, he acknowledged a day playing beach volleyball with colleagues on a riverbank.

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• Figure. 

  Pruritic rash on feet. Used with permission of J. Lemery, MD, Weill-Cornell Medical College, New York-Presbyterian Hospital, New York, NY.

His only complaint was intense pruritus at the site of the lesions, and he was afebrile, with normal vital signs. A routine CBC count and chemistry panel results were within normal limits.

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Diagnosis 

Cutaneous larvae migrans 

This nematode parasitic infection, also known as creeping eruption, is caused by skin penetration and migration of nematode larvae. Often humans are infected when bare skin comes in contact with contaminated soil. The dermatologic sequelae present as intensely pruritic, serpiginous, erythematous lesions. Humans are accidental hosts, and the larvae are limited to the dermal-epidermal junction and do not penetrate the bloodstream. It is commonly seen in subtropical and tropical areas, as well as the southern United States. Diagnosis is mostly based on the classic presentation of the lesions, and skin biopsies are not always diagnostic. It is a self-limited infestation, but the intense pruritus and risk for secondary infection necessitate treatment. Thiabendazole, albendazole, or ivermectin are considered first-line anthelmintic's.¹, ²

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References 

1. Liu L, Weller P. Trichinosis and infections with other tissue nematodes. In:  Fauci A,  Braunwald E,  Isselbacher K editor. Harrison's Principles of Internal Medicine. 14th ed.. New York: McGraw-Hill; 1998;p. 1207
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2. Mazzorana V, Maeyens E. Aquatic skin disorders. In:  Auerbach P editors. Wilderness Medicine. 5th ed.. Philadelphia, PA: Mosby; 2007;p. 1769
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