AUTOCHTHONOUS CUTANEOUS LARVA MIGRANS IN AN 8 YEAR OLD CHILD WITH AUTISM

Julija Mitrova Telenta

Julija Mitrova Telenta University Clinic of Dermatovenerology, Faculty of Medicine Ss.”Cyril and Methodious” University in Skopje, North Macedonia

Abstract

Cutaneous larva migrans (CLM) is a parasitic dermatosis caused by the epidermal migration of hookworm larvae, most commonly originating from dogs and cats. Human infection occurs through contact with soil or sand contaminated with animal feces, typically in tropical and subtropical regions.It is rare in temperate climates, including North Macedonia, but poses a diagnostic challenge when encountered. Case report: We report the case of an 8-year-old boy with autism who presented in July 2023 with an acute onset of pruritic and burning skin lesions on the plantar surface of the left foot following contact with dogs and cats. Dermatological examination revealed a well-defined erythematous serpiginous tract with associated edema and a central black line at the advancing edge. Dermoscopic evaluation demonstrated a brownish linear structure corresponding to the larval body, a serpiginous erythematous background, brown dots, scaling, and yellow-white linear structures suggestive of empty larval tunnels. Laboratory findings showed mild eosinophilia (5.2%). Treatment with oral albendazole, local cryotherapy, corticosteroids, and antihistamines resulted in marked clinical improvement within 10 days. Conclusion: This case highlights a rare presentation of Cutaneous Larva Migrans in a non-endemic region. While diagnosis is primarily clinical, dermoscopy represents a valuable noninvasive tool for confirming active or residual infestation. Early recognition and timely antiparasitic therapy are essential for rapid symptom resolution and prevention of complications. Increasing reports in non-endemic areas emphasize the need for heightened clinical awareness in the context of travel and climate change.

Key words: Cutaneous larva migrans, dermoscopy, non-endemic region.

References

1. Piccolo V. Update on dermoscopy and infectious skin diseases. Dermatol Pract Concept. 2019;10:e2020003.
2. Zalaudek I, Giacomel J, Cabo H, et al. Entodermoscopy: a new tool for diagnosing skin infections and infestations. Dermatology. 2008;216(1):14-23.
3. Hla Aye MT, Kyaw AY, Rubel AR, Han MB, Mani BI, Chong VH. Cutaneous larva migrans. QJM. 2022;115:1-2.
4. Purdy KS, Langley RG, Webb AN, Walsh N, Haldane D. Cutaneous larva migrans. Lancet. 2011;377(9781):1948.
5. Jelinek T, Maiwald H, Nothdurft H, et al. Cutaneous larva migrans in travelers: synopsis of histories, symptoms, and treatment of 98 patients. Clin Infect Dis. 1994;19:1062-1066.
6. Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis. 2008;8:302-309.
7. Feldmeier H, Heukelbach J. Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues. Bull World Health Organ. 2009;87:152-159.
8. Peric J, Lekic B, Reljic V, Cirkovic L, Skiljevic D. Cutaneous larva migrans - report of 2 new cases locally acquired in Serbia. Serbian J Dermatol Venerol. 2017;9(4):149-153.
9. Coelho WMD, Amarante AFT do, Apolinario JC, et al. Occurrence of Ancylostoma in dogs, cats and public places from Andradina city, Sao Paulo state, Brazil. Rev Inst Med Trop Sao Paulo. 2011;53:181-184.
10. Shrestha A, KC K, Baral A, Shrestha R, Shrestha R. Cutaneous larva migrans in a child: a case report and review of literature. Ann Med Surg (Lond). 2023;86(1):530-534.
11. Balassiano BCC, Campos MR, Menezes R, et al. Factors associated with gastrointestinal parasite infection in dogs in Rio de Janeiro, Brazil. Prev Vet Med. 2009;91:234-240.
12. Cayce KA, Scott CM, Phillips CM, et al. What is your diagnosis? Cutaneous larva migrans. Cutis. 2007;79:429, 435-436.
13. Centers for Disease Control and Prevention. Zoonotic hookworm - resources for health professionals. 2021.
14. Rather S, Aslam A, Younus F. Dermoscopy before and after treatment of cutaneous larva migrans. Indian Dermatol Online J. 2022;13(5):690-694.
15. Perman MJ. 10-year-old boy presents with a pruritic, blistering eruption. Infect Dis Child. 2010;23:64.
16. Kacprzak E, Silny W. Cutaneous larva migrans syndrome in travelers returning from warm climate countries. Adv Dermatol Allergol. 2004;21:24-29.
17. Hochedez P, Caumes E. Hookworm-related cutaneous larva migrans. J Travel Med. 2007;14:326-333.
18. Bouchaud O, Houze S, Schiemann R, et al. Cutaneous larva migrans in travelers: a prospective study with assessment of therapy with ivermectin. Clin Infect Dis. 2000;31:493-498.
19. Shenefelt PD, Shenefelt DA. Spiritual and religious aspects of skin and skin disorders. Psychol Res Behav Manag. 2014;7:201-212.
20. Montresor A, Stoltzfus RJ, Albonico M, et al. Is the exclusion of children under 24 months from anthelmintic treatment justifiable? Trans R Soc Trop Med Hyg. 2002;96:197-199.