Cutaneous Larva Migrans: Presentation at an Unusual Site

Sir, Cutaneous larva migrans are lesions that migrate or creep on the skin and are due to the presence of moving parasites in the skin. It is also known as creeping eruption, sandworm eruptions, plumber’s itch, and duck hunter’s itch. Causative larvae are from Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylonicum, Uncinaria stenocephala, and Bunostomum phlebotomum.[1] In humans, the most common cause is the dog hookworm and A. braziliense. Sandpits, seashore, or areas with loose, wet soil are places where humans acquire the infection. Humans are dead-end hosts. People who come into contact with such soil – such as gardeners, hunters, children who play in sandpits, and people who frequently visit the beaches are the ones affected. Once the larvae gain entry into the skin, itchy, skin-colored tortuous, linear thread-like lesions start with an advancing end, which moves at a rate of about 2 mm–3 cm/day. Usual sites of infection are the hands, feet, buttocks, and back. Sugathan[2] in 2002 reported a case of massive infestation of cutaneous larva migrans affecting the whole body. Here, we report a case of creeping eruption at an unusual and yet unreported site. A young adult, uncircumcised fisherman, reported to us with severe itching of the genitalia, which started 3 weeks ago. He consulted a doctor and was given antiscabetic treatment with no relief of symptoms. He gave a history of carrying sand from the seashore for building his own residence, wearing only boxer shorts. There was no family history of itching. He was nondiabetic, not on any medication, and gave no history of extramarital contact.