Falls in Diagnosis of Cutaneous Larva Migrans-a Case Report from Kosovo

Abstract

INTRODUCTION:Cutaneous larva migrans (CLM) is a dermatitis caused by hookworm larvae inoculation in the skin, most commonly acquired among individuals in tropical and sub-tropical areas or travelers who have visited those areas. The typical clinical presentation consists of itchy serpiginous lesion that advances.CASE REPORT:We are reporting a long time misdiagnosed case of a 37-year-old farmer from continental European region with a typical clinical presentation, and no history of traveling to endemic areas. We made the diagnosis of the CLM based on the patient’s history of itchy skin that had advanced for a few months, and clinical characteristics of the lesion in the right gluteus region consisting of erythema, papula and vesicles, together with erythematous/livid serpiginous tracks that formed an irregular and capricious path. The patient was successfully treated with oral mebendazole twice daily for three days and local therapy.

Occupational risk of cutaneous larva migrans: A case report and a systematic literature review

“…In addition, in agricultural setting, uncommon clinical presentation can occur such as hair follicle inflammation (hookworm folliculitis), most frequently in the gluteal region, probably because larvae may be transferred to human skin through contaminated clothes, towel or other objects [ 11 ]. In farm setting, moreover, co-exposure to different biological agents may evoke contextual inflammatory and/or allergic reactions that could facilitate secondary bacterial infection resulting in atypical clinical manifestations of CLM [ 28 ].…”

Very High‐ and High‐Frequency Ultrasound Features of Cutaneous Larva Migrans

“…The diagnosis is usually clinical, and only a few cases have been reported with imaging techniques, none of them with ultrasound (US). However, the clinical diagnosis, particularly in nonendemic areas, may be challenging, since some cases can have atypical morphologic characteristics; a secondary infection may alter the appearance due to itching and scratching; or the clinical lesion may mimic a nonparasitic inflammatory reaction . These issues can generate multiple medical consultations by primary care physicians, dermatologists, or emergency departments as well as a diagnostic delay of several months .…”

“…However, the clinical diagnosis, particularly in nonendemic areas, may be challenging, since some cases can have atypical morphologic characteristics; a secondary infection may alter the appearance due to itching and scratching; or the clinical lesion may mimic a nonparasitic inflammatory reaction. 4,5 These issues can generate multiple medical consultations by primary care physicians, dermatologists, or emergency departments as well as a diagnostic delay of several months. 5 We present 4 clinically confirmed cases of cutaneous larva migrans that were evaluated with color Doppler US before the initiation of medical treatment and describe the US features of this condition.…”

“…4,5 These issues can generate multiple medical consultations by primary care physicians, dermatologists, or emergency departments as well as a diagnostic delay of several months. 5 We present 4 clinically confirmed cases of cutaneous larva migrans that were evaluated with color Doppler US before the initiation of medical treatment and describe the US features of this condition.…”