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Endgames Picture Quiz

A characteristic rash

BMJ 2009; 338 doi: (Published 20 May 2009) Cite this as: BMJ 2009;338:b1451
  1. E E Craythorne, specialist registrar,
  2. S Wong, specialist registrar,
  3. R Morris Jones, consultant,
  4. A W P du Vivier, consultant
  1. 1Department of Dermatology, King’s College Hospital, London SE5 9RS
  1. Correspondence to: E E Craythorne emma_craythorne{at}

    A 53 year old man presented with an itchy, red rash on his lower leg after a trip to Brazil. He recalled having been bitten on the right ankle while on a beach and had covered the bite with a plaster. The initial bite mark on the ankle extended by 1-2 cm per day in a serpiginous pattern across the ankle and up the leg (figure). Other than intense irritation of the skin, he had no other symptoms and was systemically well.

    An itchy rash


    • 1 What is the diagnosis?

    • 2 What are the differential diagnoses?

    • 3 How is it treated?


    Short answers

    • 1 Cutaneous larva migrans is a common, tropically acquired dermatosis caused by the percutaneous penetration and migration of larvae of nematode parasites.

    • 2 Other infestations—including erythema migrans of Lyme disease, migratory myiasis, and larva currens caused by Strongyloides stercoralis—should be considered.

    • 3 Cutaneous larva migrans is self limiting, but its clinical course is shortened by effective treatment with topical and oral anthelmintics such as albendazole, thiabendazole, and ivermectin.

    Long answers

    Cutaneous larva migrans is …

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