LOEFFLER SYNDROME SECONDARY TO CUTANEOUS LARVA MIGRANS

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Loeffler syndrome is a rare disorder consisting transient, migratory pulmonary infiltrates and peripheral eosinophilia. Ascaris infection the most common cause parasitic Loeffler. (1) Hookworm-related cutaneous larva migrans (CLM) characterized by migrating rash can affect travelers visiting tropical climates. The diagnosis usually made clinically based on characteristic in setting parasite exposure. (2) Extra-dermal manifestations CLM are but have been reported. We report case complicated syndrome. CASE PRESENTATION: A healthy 23-year-old woman presented with one month pruritic rash, pleuritic chest pain, dyspnea, non-productive cough. One prior, she traveled to Puerto Rico spent time sandy beaches. Five days after returning, developed serpiginous, raised, her back (Figure 1A). Her labs were notable for eosinophilia 10.0%, (absolute eosinophil count (AEC) 0.95x10^3/µl), which peaked at 24.3% (AEC 2.57x10^3/µl).Computed tomography (CT) revealed multifocal, patchy, ground-glass opacities small areas cavitation throughout all five lobes lungs 2A). Serologic markers infectious etiologies, connective tissue disease, autoimmunity negative. Bronchoscopy was performed no etiology. Skin biopsy showed epidermal extravasated red blood cells, consistent burrows 1B). Repeat imaging (10 presentation) 2B).A CT scan initial presentation marked improvement despite lack directed therapy 2C). However, dyspnea persisted. She then treated 12 mg oral ivermectin two days, resulted complete resolution pain dyspnea. Follow-up week treatment (4.8%, AEC 0.42x10^3/µL). DISCUSSION: This details patient While commonly confined skin, it be part systemic including eosinophilia, eosinophilic enteritis, or infiltrates. As seen this case, generally benign self-limited, resolving spontaneously regardless treatment. Corticosteroid use has reported syndrome, standard symptom management etiology specific. (3) In symptoms resolved therapy. CONCLUSIONS: Clinicians should consider as patients appropriate history. Treatment underlying lead rapid symptomatic relief. REFERENCE #1: Guerrant, R. L., Walker, D. H., & Weller, P. F. (2011). Tropical Infectious Diseases: Principles, Pathogens Practice E-Book. Elsevier Health Sciences. #2: Heukelbach, J., Feldmeier, H. (2008). Epidemiological clinical characteristics hookworm-related migrans. Lancet diseases, 8(5), 302-309. #3: De Giacomi, F., Vassallo, R., Yi, E. S., Ryu, J. (2018). Acute pneumonia. Causes, diagnosis, management. American journal respiratory critical care medicine, 197(6), 728-736. DISCLOSURES: No relevant relationships Imo Akpan, source=Web Response Neda Bionghi, Donald Dietz, Ariel Eber, Christina Eckhardt, David Furfaro, Christine Kim Garcia, Michael Murn, DEBORAH THEODORE,