Answer VizD 1.1

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Answer to 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.

Questions:

1. What is the diagnosis?

2. What is the most common treatment?

3. Is the prognosis favorable or unfavorable?

Answers:

1.  Dx: Cutaneous larva migrans (CLM)

A skin disease in humans, caused by the larvae of various nematode parasites, the most common of which is Ancylostoma braziliense

These parasites are found in dog and cat feces and although they are able to infect the deeper tissues of

Life Cycle of Hookworm (not CLM variety)

these animals (through to the lungs and then the intestinal tract), in humans they are only able to penetrate the outer layers of the skin and thus create the typical wormlike burrows visible underneath the skin. The parasites apparently lack the collagenase enzymes required to penetrate through the basement membrane deeper into the skin.

2.  Treatment:

CLM can be treated in a number of different ways:

• Systemic (oral) agents include albendazole (trade name Albenza) and ivermectin (trade name Stromectol).

• Another agent which can be applied either topically or taken by mouth is thiabendazole (trade name Mintezol), an anti-helminthic.

• Topical freezing agents, such as ethyl chloride or liquid nitrogen, applied locally can freeze and kill the larvae (but is often a hit-or-miss proposition).

3.  Prognosis: Good.  The condition is self-limited

Thank you to everyone who submitted their answer.  Stay tuned for next week’s VizD

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.