VizD Vol 1.1

Case 1:1

A 32-year-old man presents to your ED complaining of intense pruritis to the plantar portion of his foot.  He states that he returned from Guyana just two days earlier where he spent a week providing medical care to an indigenous community.  His sleeping quarters was close to the beach where he went on daily jogs.   On exam, you note the lesion seen below.


1. What is the diagnosis?

2. What is the most common treatment?

3. Is the prognosis favorable or unfavorable?

Please click on the “comments” link or post your answer in the “reply box”.  You will not see your answer post until next week when all of the submitted answers will be posted.  Good luck!

VizD is a weekly contest of an interesting or pathognomonic image from emergency medicine. Its goal is to integrate learning into a fun and relaxed environment. All images are original and are posted with the consent of the patient.

10 Responses

  1. 1: Cutaneous larva migrans
    2: Thiabendazole
    3: Excellent

    I lived in Guyana doing volunteer work for 10 months. Luckily I didn’t get it!!

  2. 1. Hookworm
    2. Albendazole/mabendazole or freezing
    3. Good prognosis with appropriate treatment

  3. 1) Hookworm
    2) Albendazole 400mg QDay x 5 days, topical antibiotic cream or ointment, elevate foot and keep clean.
    3) Favorable

  4. Cutaneous larva migrans
    usually self limiting so….favorable

  5. DX: CutaneousLarval Migrans

    TX:/ PX: – No treatment required, it goes away.
    But you can use Antihistamines and antibiotic ointments for the symptoms.

    Should have worn SHOES!!!!

  6. 1. Diagnosis:
    Ancyclostomiasis (Hookworm, Cutaneous Larva Migrans [CLM])
    organism: Ancyclostoma braziliense

    2. Treatment:
    mebendazole 100 mg PO BID x 3 days
    albendazole 400 mg PO once
    pyrantel pamoate 11 mg/kg PO once up to 1 g

    intestinal obstruction may necessitate surgery

    3. Prognosis:
    Likely to be cured with Rx. Reinfection would be likely if patient were to return to high risk region and walk around barefoot.

  7. This is Brian McMichael.

    1. Onchocercias (river blindness)
    2. ivermectin (Mectizan) with doxycycline adjunct
    3. Favorable with treatment Q6-12 months for the lifetime of the adult worm (approximately 12-15 years) with resolution of most minor Sxs. However, chorioretinitis, blindness, skin atrophy, and depigmentation do not improve with treatment. Patients who are blind have an increased mortality rate, with an average life expectancy of 10 years.

  8. hookworm, albendazole, favorable

  9. Answer: Chigger mite infestation
    Treatment: Symptomatic treatment, oral antihistamines, and topical steroids
    Prognosis: favorable

  10. 1) Chigger mites
    2) Symptomatic care, topical steroids, oral antihistamines
    3) Favorable prognosis

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