Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
The picture quiz of cutaneous larva migrans reminds me of the active
75yr old lady I once saw with the same thing on her abdomen. But she had
not travelled abroad & never lay on beaches.
She had several of the typical serpiginous rashes, which had slowly
extended over her abdomen for several days and in addition there were
multiple insect bites over her abdomen.
The serpiginous rashes were classic of larva migrans, but we
struggled to identify how she might have got it, until I told her it is
caught from sand. She then recalled carrying sandbags in her garden and
using the sand. She had carried the opened bag close to her abdomen. There
must have been small biting insects and parasites in the sand which were
in contact with her abdominal skin.
The perils of sandbags!
Sadly I didn't take a photo.
Editorial note The patient whose case is described has given her signed informed consent to publication.