Cutaneous Larva Migrans

A linear, severely pruritic rash erupted on the lateral and plantar aspects of the left foot of a 72-year-old woman who had recently been camping on a Caribbean beach. Antihistamines and locally applied antifungal agents offered no relief.

What is your clinical impression?

A linear, severely pruritic rash erupted on the lateral and plantar aspects of the left foot (A) of a 72-year-old woman who had recently been camping on a Caribbean beach. Antihistamines and locally applied antifungal agents offered no relief.

A biopsy of the lesion was unrevealing. A complete blood cell count showed eosinophilia of 12%. The travel history and clinical presentation of a wavy, meandering track on the foot confirmed the diagnosis of cutaneous larva migrans, or creeping eruption. The patient had been infected with the larva of Ancylostoma braziliense as she walked barefoot on the Caribbean beach. The ova-contaminated feces of dogs and cats are deposited on the sand, where the eggs hatch; the larvae may then penetrate the basal area of human skin.

This patient was given oral ivermectin. The rash and symptoms cleared completely (B).

(Case and photographs courtesy of Navin M. Amin, MD, of Kern County Medical Center, Bakersfield, Calif.)