Rita Ribeiro Martins, Catarina Ferreira Nunes, Francisca Costa, Paula Correia
Department of Pediatrics, Prof. Dr. Fernando Fonseca Hospital, Amadora, Portugal
Address for Correspondence: Rita Ribeiro Martins, Hospital Prof. Doutor Fernando Fonseca E.P.E., IC 19, 2720-276 Amadora, Portugal.
Email: rita.r.martins@hff.min-saude.pt
Keywords : Cutaneous larva migrans, Helminth infections, Tropical disease
Question: A healthy 4-year-old girl came to the Emergency Department with a 1-week history of an itchy and painful skin rash on the palm of her right hand. Initially, the rash was vesicular and associated with a fever that started 48 hours before. Epidemiological context was relevant for a recent 2 month-visit to Guinea-Bissau, where she had contact with sandy areas.
Upon observation, she presented an erythematous, painful lesion, approximately 1 cm wide and 2 cm long, on the palm of her right hand, adjacent to a lesion with whitish relief and a serpentine shape, measuring about 4 cm in length (Figure 1). Blood tests revealed an increase in C-reactive protein (3.72 mg/dL), a normal leukogram (no eosinophilia), negative blood culture, and negative anti-Toxocara spp-Larva Migrans Visceral antibody. The girl was prescribed flucloxacillin and oral antihistamine, and her condition was closely monitored. In the following days, the lesion acquired a migratory nature and increased in size (Figure 2).
Figure 1. Initial observation of the hand lesion.
Figure 2. The second observation of the hand lesion (one week later).
