Cutaneous Larva Migrans Presenting With Folliculitis

A 28-year-old woman returned from a scuba-diving holiday in Thailand with an intensely itchy rash on her anterior abdominal wall and buttocks. This started as a single pustule but developed into an extensive eruption of pruritic papules. Three days later, both buttocks were affected. Shewas otherwise well and had no fever, cough, dyspnea, or diarrhea. Therewasno response tooral flucloxacillin which was prescribed by a primary care physician. Shepresented toour emergency clinic, andonexamination, there were follicular papules with occasional serpiginous tracts on the right anterior abdominal wall (Figure 1) and both buttocks. There was no dermographism, burrows, or lymphadenopathy. She had a peripheral eosinophilia of 3.77 × 10/L (0.0–0.4 × 10/L). HIV serology was negative. A diagnosis of follicular cutaneous larvamigrans (CLM) was performed, and she was treated with a single dose of oral ivermectin (200 μg/kg). The pruritus settled within 4 days and the palpable eruption 10 days later. On review 1 month later, the rash had faded, leaving macular post-inflammatory erythema (Figure 2), and her eosinophilia had resolved. Cutaneous larva migrans is a common skin infestation in travelers returning from tropical destinations, although it can beacquired incooler climatesandeven in theUnitedKingdom. The eruption is caused by larvae of various hookworm nematodes, which usually live within the intestines of cats and dogs, penetrating and migrating into the skin. Ancylostoma