Tropical pruritus

A 52-year-old French woman without medical history had developed right foot pruritus three days after a prolonged barefoot walk on a beach in Rio de Janeiro, Brazil. She consulted with a local physician, who made a clinical diagnosis of cutaneous larva migrans. She was subsequently started on albendazole 400 mg daily for five days.

After an initial improvement, symptoms recurred and worsened on day 4 of treatment, without iterative exposure to contaminated soil.

She subsequently went back to France and presented with an itchy, erythematous serpiginous eruption on the sole of her right foot (Fig. 1), consistent with the diagnosis of cutaneous larva migrans.

Fig. 1
Primary resistance to albendazole was suspected, and she was therefore given ivermectin 200 μg/kg as a single-dose. Ten days later, a marked regression of cutaneous signs was seen, and the patient reported a full regression of pruritus. No recurrence was seen with a follow-up of three months.

Albendazole and ivermectin are two drugs of choice in the treatment of cutaneous larva migrans. Although a single dose of albendazole is less effective than a single dose of ivermectin,¹ a 5-7 days of oral albendazole (400 mg daily) is considered to be an effective alternative in countries without ivermectin.² In our case, ivermectin was a better option for the treatment of the infection.

References

• ¹
  Blackwell V, Vega-Lopez F. Cutaneous larva migrans: clinical features and management of 44 cases presenting in the returning traveller. Br J Dermatol. 2001;145: 434-7.
• ²
  Heukelbach J, Feldmeier H. Epidemiological and clinical characteristics of hookworm-related cutaneous larva migrans. Lancet Infect Dis. 2008;5:302-9.

Publication Dates

• Publication in this collection
  Jul-Aug 2014

History

• Received
  06 Mar 2014
• Accepted
  18 Mar 2014