Mathews Journal of Case Reports

2474-3666

Previous Issues Volume 9, Issue 5 - 2024

Extensive Cutaneous Larva Migrans: Report of A Case in Yemen

Mohammad Ali Alshami1, Ahlam Mohammad Alshami2, Hadeel Mohammad Alshami1

1Dermatology Department, Faculty of Medicine and Health Sciences, Sana’a University, Sana’a, Yemen

2Department of Conservative Dentistry, Faculty of Dentistry, Sana’a University, Sana’a, Yemen

*Corresponding author: Mohammad Ali Alshami, Dermatology Department, Faculty of Medicine and Health Sciences, Shamlan street 1064/18/10, Sana’a University, Sana’a, Yemen, Telephone: +967-733760082, Fax: +967-1202646, ORCID: 0000-0003-0083-7866, Email: [email protected].

Received Date: June 05, 2024

Published Date: June 21, 2024

Citation: Alshami MA, et al. (2024). Extensive Cutaneous Larva Migrans: Report of A Case in Yemen. Mathews J Case Rep. 9(5):168.

Copyrights: Alshami MA, et al. © (2024).

ABSTRACT

Cutaneous larva migrans (CLM) is the most common helminthic dermatosis, typically found in tropical regions. It is most frequently caused by larvae of the dog or cat hookworm, Ancylostoma braziliense, which can penetrate and migrate through the host's epidermis by releasing degradative enzymes. Diagnosis is generally based on the characteristic clinical presentation, and empirical treatment with oral anthelmintics, such as albendazole and ivermectin, is usually initiated. This report details the case of a 47-year-old man with a 2-month history of an itchy, serpiginous eruption on his back, abdomen, buttock, and thigh. He was successfully treated with oral albendazole 400 mg/day for three days. This is the first documented case of CLM in Yemen.

Keywords: Cutaneous, Larva Migrans, Ancylostoma, Travel medicine, Skin, Zoonotic.

INTRODUCTION

Cutaneous larva migrans (CLM) is most often caused by zoonotic hookworm (Ancylostoma braziliense) larvae, which can penetrate and migrate through the epidermis of the host using degradative enzymes [1,2]. Additionally, CLM is known as creeping eruption, sandworm eruption, plumber’s itch, duck hunter’s itch, and epidermatitis linearis migrans [3]. However, it is most commonly known as creeping eruption because the lesions move as the larvae move in the epidermis. The first report of CLM was described by Lee and published in 1874. Crocker coined the term “cutaneous larva migrans” in 1893. [2] In 1896, Himmelstein proved the parasitic etiology of CLM [4]. In 1929, it was determined that CLM comprises a creeping eruption produced by zoonotic hookworm larvae attributable to Ancylostoma caninum nematode larvae [5]. For many years, the terms “CLM” and “creeping eruption” have been used interchangeably. However, in 2004, Caumes and Danis correctly designated CLM as a syndrome and creeping eruption as a clinical sign [5].

CLM is diagnosed clinically, and treatment comprising oral anthelmintics (albendazole and ivermectin) is administered empirically [6]. Creeping eruption is caused by migrating larvae of zoonotic hookworm and other nematode larvae, adult worms such as Gnathostoma spp. and Loa loa, adult Sarcoptes scabiei (scabies mites), and parasitic fly larvae (migratory myiasis) [7]. Hence, the term “hookworm-related CLM” was introduced to describe CLM caused by the migration of hookworm larvae from dogs and cats within human epidermis [8]. Hookworm-related CLM mainly occurs in resource-poor countries; however, it has been sporadically observed in high-income countries [9]. Tourists who have visited tropical regions have also exhibited hookworm-related CLM. Linear, intensely itchy, and serpiginous tracks that move through the skin are pathognomonic of CLM [9]. These tracks are associated with exposure to hookworm-infested soil or sand. The itchiness is commonly severe and hinders sleep [9]. The larvae remain confined to the epidermis because they cannot penetrate the basal membrane of the human skin; consequently, they cannot complete their lifecycle [9]. Therefore, hookworm-related CLM is a self-limiting disease that is clinically diagnosed. The drug of choice for treating CLM is ivermectin (single dose of 200 μg per kg bodyweight) [9]. However, repeated treatment comprising albendazole (400 mg/day) is a good alternative in countries where ivermectin is unavailable [9]. This report describes the case of a young Yemeni man with extensive CLM and unusual features.

CASE REPORT

A 47-year-old man presented with a 2-month history of intensely itchy serpiginous eruptions on different areas of his body. A cutaneous examination revealed multiple migratory, serpiginous, and curvilinear erythematous lesions on his back, abdomen, buttocks, and thighs (Figure 1a-d). The lesions disappeared within 9 days of initiating oral albendazole treatment (400 mg/day for 3 days). The patient reported walking barefoot in sand contaminated with the feces of dogs and cats. This case was exceptional because the patient presented with multiple tracks, lesions distributed over many body areas, and the presence of simultaneous old and new tracks, which are unusual features that have not been reported previously. In this case report, albendazole was used as the treatment method due to the unavailability of ivermectin. Notably, the efficacy of albendazole in this case appears to be higher than in other reported cases, as the lesions disappeared within just 9 days, whereas it typically takes 4-6 weeks to achieve similar results.

Figure 1a. Upper back close-up, Multiple papulonodules, serpiginous burrows, almost symmetrically bilaterally distributed.

Figure 1b. About 15 cm long erythematous, serpiginous burrow, on the posterolateral aspect of the right side of the back.

Figure 1c. An about 15 cm long serpiginous burrow is acutely erythematous on its distal end and chronically scaly on the proximal end, seen on the anterolateral aspect of the right side of the abdomen.

Figure 1d. two serpiginous tracks are visible on the posterolateral aspect of the left thigh.

RESULTS

The lesions disappeared within 9 days of initiating oral albendazole treatment (400 mg/day for 3 days).

DISCUSSION

CLM presents as erythematous, raised, migratory, and serpentine lesions that respond to treatment with anthelmintics [9]. Patients often report a history of walking barefoot in soil or sand infested with hookworm larvae [10]. CLM is commonly observed in tropical and subtropical countries [6]. However, only 20 articles that have included 22 patients with extensive CLM have been published (Table 1). This is the first report of a case of CLM observed in Yemen. CLM is clinically diagnosed when its characteristic serpiginous, migrating tracks are observed. A biopsy is not performed because the parasites are rarely found in the specimens. CLM should be differentiated from diseases caused by other nematode infestations such as larva currens, which is caused by Strongyloides stercoralis and involves rapid track movement (a few centimeters per hour) [11]. Most patients present with one or a few tracks on the extremities or gluteal region after contact with infested soil [7]. Prolonged exposure of large skin surfaces to contaminated soil increases the risk of infection by a large number of larvae, as observed in the present case, resulting in multiple tracks on different sites. Our patient presented with both old and new lesions, suggesting repeated infections and a lack of treatment for more than 2 months. This case demonstrates the need for improved medical knowledge and public education regarding the mode of infestation (skin contact with sand containing larvae of dog or cat hookworms), preventive measures (avoiding walking barefoot in sand contaminated with the feces of dogs and cats), and treatment of CLM.

Table 1. Reported cases of extensive cutaneous larva migrans

Year

1st Author

Title

Journal

Country

Age &sex

number

Sites affected

2001

Gourgiotou K

Treatment of widespread cutaneous larva migrans with thiabendazole

J Eur Acad Dermatol Venerol

Greece

45YF

1

Buttock, foot

2002

Karthikeyan K

Disseminated Cutaneous Larva Migrans

Indian J Dermatol

India

30YM

1

All body except face

2003

French SJ

Severe cutaneous larva migrans in traveler to Jamaica, West Indies

J Travel Med

Jamaica

18YF

1

Chest, breast, back

2004

Mehta VR

Extensive larva migrans

Indian J Dermatol Venereol Leprol

India

26YM

1

Arms, back

2006

Malvy D

Extensive cutaneous larva migrans with folliculitis mimicking multimetameric herpes zoster presentation in an adult traveler returning from Thailand

J Travel Med

France

42YM

1

Abdomen, Flank

2008

Jensenius M

Extensive hookworm-related cutaneous larva migrans in Norwegian travellers to the tropics

Travel Med Infect Dis

Norway

37YM

1

Thighs, hips, genitalia

2008

Jensenius M

Extensive hookworm-related cutaneous larva migrans in Norwegian travellers to the tropics

Travel Med Infect Dis

Norway

29YF

1

Abdomen

2008

Tomović M

Two cases of probable endogenous extensive cutaneous larva migrans in Serbia

Acta Dermatovenerol Alp Pannonica Adriat

Serbia

63YM

1

Abdomen

2008

Tomović M

Two cases of probable endogenous extensive cutaneous larva migrans in Serbia

Acta Dermatovenerol Alp Pannonica Adriat

Serbia

70YM

1

Back

2010

Te Booij M

Löffler syndrome caused by extensive cutaneous larva migrans. A case report and review of the literature

Dermatol Online J

The Netherlands

27YM

1

Both Feet

2011

Wambier CG

Generalized Serpiginous Eruption during Immunosuppressive Treatment for Leprosy Reactive Neuritis

PLoS Negl Trop Dis

Brazil

49YM

1

Abdomen, back

2014

Sharma A

Extensive Cutaneous Larva Migrans. A Case Report

Indian J Public Health Res Dev

India

65YM

1

Abdomen, back

2015

González-Ramos L

Disseminated cutaneous larva migrans infestation

Semergen

Spain

53YF

1

Chest, breasts, arm

2016

Comparin C

Extensive Cutaneous Larva Migrans with Eczematous Reaction on Atypical Localization

Am J Trop Med Hyg

Brazil

32YM

1

Back

2017

Rafat M

Extensive cutaneous larva migrans. A case report

Journal of Pakistan Association of Dermatologists

Pakistan

50YF

1

Right Leg, left thigh

2018

Del Giudice P

Extensive Cutaneous Larva Migrans

Am J Trop Med Hyg

France

18YM

1

Abdomen, chest

2018

Tianyi FL

An unusual case of extensive truncal cutaneous larva migrans in a Cameroonian baby, a case report

J Med Case Rep

Cameroon

9MF

1

Abdomen, chest

2019

Gao YL

Cutaneous larva migrans with Löeffler's syndrome

Am J Trop Med Hyg

China

26YF

1

Right arm, thighs

2019

Gunawan H

Bullous Cutaneous Larva Migrans and Generalized Cutaneous Larva Migrans. A Rare Clinical Manifestation

Open Dermatol J

Indonesia

20YM

1

Scalp, neck, chest, back, buttock, scrotum, extremities

2019

Lopes VV

Disseminated cutaneous larva migrans in a 7-year-old patient

J. Health Biol Sci

Brazil

7YM

1

Right arm, elbow, hand, thigh, knee

2021

Ng J

A Unique Case of Cutaneous Larva Migrans and Asymptomatic Löeffler’s Syndrome

Cureus

USA

52YM

1

Abdomen, foot

2022

Tasbun F

An unusual case of extensive truncal Cutaneous larva migrans from remote area in an Indonesian adult male. A case report

Indones J Med health

Indonesia

21YM

1

Abdomen, back

M: male, F: female, Y: year

CONCLUSION In conclusion, oral albendazole (400 mg/day for 3 days) was effective and safe in treating extensive CLM.

REFERENCES

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  2. Sałamatin R, Knysz B, Paszta W, Lelonek E, Matos O, Wesołowska M. (2023). Cutaneous larva migrans: A One Health Perspective on Familial Infection Among Tourists Returning from Southeast Asia. Clin Cosmet Investig Dermatol. 16:3375-3382.
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