Spot Diagnosis

Creeping eruption: an image to remember

Ana Isabel Foles, Diana Silva, Ana Cristina Figueiredo, Cristina Hércules
Pediatrics Department, Centro Hospitalar de Setúbal, Setúbal, Portugal

Address for Correspondence: Ana Isabel Foles, Rua Camilo Castelo Branco, Aptd. 140, Setúbal, Portugal.
Email: aibfoles@gmail.com
Keywords : cutaneous larva migrans, hookworms, creeping rash, serpiginous track
Question :
A 2-years-old female patient, previously healthy, presented with an intense pruritic rash in the gluteal region. The skin lesion started as a single pustule, growing into a creeping migratory track within three days. No fever or other symptoms were reported.
The patient lived in Portugal, in an apartment in an urban area, without contact with any animals. Symptoms appeared during spring season. At the time, the child and her family stayed preferably at home and avoided public spaces, since the country was in lockdown due to the COVID-19 pandemic.
However, the child had traveled to Brazil three months earlier, where she had frequent contact with animals, played in the soil at parks and had been in contact with sand at a few beaches. The child's cohabitants were always asymptomatic.
Physical examination revealed an erythematous and elevated eruption, as a serpiginous track (Figure 1) measuring 30x3 mm, on the gluteal region. There were no other skin lesions, no lymphadenopathy or other physical findings.
The diagnosis of cutaneous larva migrans (CLM) infection was considered as the probable cause of the lesions. The patient was treated with oral Albendazole 400 mg/day, for three days. The pruritus resolved right at the end of treatment and the skin rash faded completely in seven days.

Figure 1. Serpiginous track on the gluteal region, measuring 30x3 mm.
<b>Figure 1.</b>  Serpiginous track on the gluteal region, measuring 30x3 mm.


What is the diagnosis?
 
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