Hookworm-related Cutaneous Larva Migrans with Exceptional Multiple Cutaneous Entries

Hookworm-related Cutaneous Larva Migrans (HrCLM) is a pruritic serpiginous cutaneous eruption caused by animal hookworms commonly found in tropical and subtropical areas, especially the Southeastern United States. We describe here a very exceptional HrCLM case showing multiple larva entries/lesions in a 63-yearold white male living in Miami. Clinically he presented with multiple pruritic erythematous serpiginous tracks on his left anterior leg, left calf, and right thigh. While skin biopsies failed to demonstrate larva itself, the overall histological features supported multiple larva tracks as showing several small intra-epidermal cavities with eosinophil-rich dermal inflammation. The patient was treated with Ivermectin 200 mcg/kg daily per OS for 2 days, and his cutaneous lesions subsided within 1 week of the treatment. This case exemplifies that even though the clinical presentation of HrCLM is extensive with multiple cutaneous larva tracks, it is still should be treated with a broad-spectrum antiparasitic agent at normal dosage. We also discuss literature-based characteristic geographical and clinical features of HrCLM and treatment options. Figure 1: Clinical presentation. Erythematous serpiginous larva tracks associated with hyper-pigmented macules and crusts. (A) Posterior surface of right calf. (B) Right anterior thigh. Citation: Borda LJ, Kallis PJ, Griffith RD, Giubellino A, Cho-Vega JH. Hookworm-related Cutaneous Larva Migrans with Exceptional Multiple Cutaneous Entries. J Clin Investigat Dermatol. 2017;5(1): 4. J Clin Investigat Dermatol 5(1): 4 (2017) Page 02 ISSN: 2373-1044 Initial treatment was aimed at eradication of the hookworm larvae. He was treated with Ivermectin 200 mcg/kg PO daily for 2 days (15 mg PO the first day and 15 mg PO the second day) and triamcinolone 0.1% ointment twice daily for pruritus. The lesions subsided after one week with treatment.