Cutaneous Larva Migrans Clinical Presentation

Updated: Sep 10, 2018
  • Author: David T Robles, MD, PhD, FAAD; Chief Editor: William D James, MD  more...
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Presentation

History

History findings may be as follows:

  • Tingling/prickling at the site of exposure within 30 minutes of penetration of larvae, although Archer described a case of late-onset cutaneous larva migrans (CLM) [14]

  • Intense pruritus

  • Erythematous, often linear lesions that advance

  • Often associated with a history of sunbathing, walking barefoot on the beach, or similar activity in a tropical location

Predispositions to contracting cutaneous larva migrans include the following:

  • Hobbies and occupations that involve contact with warm, moist, sandy soil

  • Tropical/subtropical climate travel

  • Barefoot beachgoers/sunbathers

  • Children in sandboxes

  • Carpenter

  • Electrician

  • Plumber

  • Farmer

  • Gardener

  • Pest exterminator

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Physical Examination

Cutaneous signs of cutaneous larva migrans (CLM) include the following:

  • Pruritic, erythematous, edematous papules and/or vesicles

  • Serpiginous (snakelike), slightly elevated, erythematous tunnels that are 2- to 3-mm wide and track 3-4 cm from the penetration site

  • Nonspecific dermatitis

  • Vesicles with serous fluid

  • Secondary impetiginization

  • Tract advancement of 1-2 cm/day

Systemic signs are rarely seen but may include, peripheral eosinophilia (Loeffler syndrome), [15] migratory pulmonary infiltrates, and increased immunoglobulin E (IgE) levels.

Lesions are typically distributed on the distal lower extremities, including the dorsa of the feet and the interdigital spaces of the toes, but can also occur in the anogenital region, the buttocks, the hands, and the knees. Scalp lesions have been reported. [16]

See the images below.

A patient who was sunbathing nude on a beach in Ma A patient who was sunbathing nude on a beach in Martinique presented with classic erythematous, serpiginous tracts on the left heel.
Cutaneous larva migrans on the right thumb. Cutaneous larva migrans on the right thumb.
Cutaneous larva migrans on the left thigh. Cutaneous larva migrans on the left thigh.
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Complications

A secondary bacterial infection in patients with cutaneous larva migrans (CLM), usually with Streptococcus pyogenes, may lead to cellulitis.

Allergic reactions may occur.

On rare occasions, Loeffler syndrome has been reported. [15]

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