Simultaneous Larva Migrans and Larva Currens Caused by Strongyloides stercoralis: A Case Report

Strongyloidiasis is an infectious disease caused by the Strongyloides stercoralis larvae, which penetrate the skin, go through the lymphatic circulation, and migrate to the lungs before reaching the intestines. They mature and may cause cutaneous strongyloidiasis, known as larva currens because of the quick migratory rate of the larva. The authors describe a case in which the larvae did not follow their natural lymph route, and after penetrating into the intertriginous area, they migrated to the dermis, developing larva migrans in the early phase, and later associated with the typical lesions of larva currens. The diagnosis was confirmed by the presence of larva in the skin biopsy. 1. Introduction Strongyloides stercoralis is especially endemic in many tropical countries, where it has become a matter of concern in the public health area [1–7]. The special characteristic features of its life cycle are chronicity, autoinfection, and easy dissemination. It is a parasitic disease difficult to diagnose as it requires the direct visualization of the larvae [1]. The infection is asymptomatic in most cases; however, the pathognomonic skin lesion of chronic strongyloidiasis is the larva currens [2, 3]. Its diagnosis may be difficult to obtain due to atypical manifestations [3]. In this study, we described a rarely observed case of simultaneous larva migrans and larva currens caused by Strongyloides stercoralis. 2. Case Report A healthy 36-year-old white man from the city of Porto Alegre, RS, Brazil, was fishing barefoot near a pond and after a period of 24 hours developed some cutaneous hemorrhagic blisters on his left foot (Figure 1). In 3 days, such condition evolved into pruritic, linear to serpiginous, erythematous urticarial lesions in the left lower limb and reached his left thigh (Figures 2 and 3). Progressively, some new urticarial, linear lesions appeared in his trunk. He denied using any medications and did not report any signs or symptoms. Figure 1: Area larvae penetration. Hemorrhagic blisters in the area: the larvae penetrated the skin and the purpuric serpiginous lesions in the back of the left foot. Figure 2: Larva migrans. Diffuse purpuric lesions showing the various routes the larvae took in the left thigh. Figure 3: Biopsy site in the popliteal region. There were no changes in the blood, stool, and partial parasitological urine tests, except for the eosinophilia in the blood test. The initial diagnosis was vasculitis due to the purpuric lesions; however, with the emergence of some lesions in the trunk, there was the chance that it could be