Hookworm-related Cutaneous Larva Migrans with Exceptional Multiple Cutaneous Entries

Hookworm-related Cutaneous Larva Migrans (HrCLM) is a pruritic serpiginous cutaneous eruption caused by animal hookworms commonly found in tropical and subtropical areas, especially the Southeastern United States. We describe here a very exceptional HrCLM case showing multiple larva entries/lesions in a 63-yearold white male living in Miami. Clinically he presented with multiple pruritic erythematous serpiginous tracks on his left anterior leg, left calf, and right thigh. While skin biopsies failed to demonstrate larva itself, the overall histological features supported multiple larva tracks as showing several small intra-epidermal cavities with eosinophil-rich dermal inflammation. The patient was treated with Ivermectin 200 mcg/kg daily per OS for 2 days, and his cutaneous lesions subsided within 1 week of the treatment. This case exemplifies that even though the clinical presentation of HrCLM is extensive with multiple cutaneouslarva tracks, it is still should be treated with a broad-spectrum antiparasitic agent at normal dosage. We also discuss literature-based characteristic geographical and clinical features of HrCLM and treatment options.