Cutaneous larva migrans

Background
  • Also known as creeping eruption or sandworm disease[1]
  • Caused by movement of hookworm (helminth) larvae through epidermis[2]
    • Ancylostoma caninum and Ancylostoma braziliense are most common pathogens
    • Typically occurs due to contact with dog/cat feces in soil/sand
    • More common in warm/tropical areas, particularly during rainy season
    • History is typically of a patient sunbathing, walking on the beach, etc in a tropical environment[1]
CLM on thigh of child
CLM on leg of 32y/o M

Clinical Features
  • Pruritic, serpiginous eruption[2]
    • Pruritus can be severe and intractable[1], and can lead to impaired sleep and mood disturbance[3]
    • Usually unilateral, but can be bilateral
    • Linear, moving lesions
    • Hand, feet, buttock most commonly affected. [4]

Complications
  • Loeffler's Syndrome[5]
    • Respiratory symptoms, pulmonary infiltrates, and peripheral eosinophilia.
    • Believed by some to be a systemic immune reaction to the parasite but exact pathogenesis unknown.
    • Treatment: treating parasitic infection leads to resolution of the pulmonary symptoms.

Differential Diagnosis

Papules

Sub Q Swelling and Nodules

Ulcers

Linear and Migratory Lesions

See also domestic U.S. ectoparasites

Evaluation
  • Clinical diagnosis, based on history and physical exam

Management
  • Self-limited condition - larvae die within 2-8 weeks[2]
    • Goal of treatment is to relieve severe pruritus
  • First Line: ivermectin 200ug/kg, single dose. [6]
    • Alternatives: Albendazole 400mg orally for 5 to 7days OR Topical tiabendazole 10-15% TID for 5 to 7days
  • Mebendazole has poor oral bioavailability and does not work for cutaneous larva migrans[3]

Disposition
  • Discharge


See Also

References
  1. Vano-Galvan S, Gil-Mosquera M, Truchuelo M, Jaén P. Cutaneous larva migrans: a case report. Cases Journal. 2009;2:112. doi:10.1186/1757-1626-2-112.
  2. Prickett KA, Ferringer TC. What's eating you? Cutaneous larva migrans. Cutis. 2015 Mar;95(3):126-8.
  3. Kincaid L, Klowak M, Klowak S, Boggild AK. Management of imported cutaneous larva migrans: A case series and mini-review. Travel Med Infect Dis. 2015 Jul 29.
  4. Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8
  5. Pascual J, Laoteppitaks C. Unique Rash after Beach Vacation. Journal of Emergency Medicine. 2017 June;52(6):878-879. Epub 2017 April 8
  6. Feldmeier H, Schuster A. Mini-review: Hookwarm-related cutaneous larva migrans. Eur J Clin Microbiol Infect Dis (2012) 31:915-918
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