Issue: 2020 > March > photo quiz

Answer to Photo Quiz Multiple curvilinear lesions on a patient’s back

A. Sil, G.S. Mukherjee, D.B. Bhanja, A. Panigrahi
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Based on history and characteristic cutaneous features, a diagnosis of multifocal cutaneous larva migrans (CLM) was established. Oral ivermectin (12 mg; 200 μg/kg) prescribed on two successive days, led to symptomatic relief and cessation of tract extension.
CLM, also termed as “creeping eruption”, is a parasitic infestation produced by burrowing of the larva of Ancylostoma braziliense.1 It is most commonly found in tropical and sub-tropical geographic areas, and is endemic in the Caribbean, Central and South America, Africa, and South-East Asia. The larva enters intact or abraded skin following exposure to soil contaminated with faeces.2 Feet, hands, buttocks, and genitalia are usually affected. Secondary infection and rarely Loeffler syndrome (allergic pulmonary response) may complicate the creeping eruption. Oral ivermectin or albendazole provides excellent response.3
The purpose of documenting this condition is to highlight the unusual features of this common tropical condition - mode of acquisition, involvement of the entire back, and multifocal presentation. In this era of global migration, clinicians worldwide should promptly diagnose and treat such endemic disorders.