Emerging Autochthonous Cutaneous Larva Migrans in Portugal

To the Editors: A 7-year-old boy presented to the emergency department with pruritic skin lesions for 2 days. He was afebrile and had no other symptoms. He had never traveled outside of Portugal. His mother is a farmer in Condeixa, a rural area where the patient frequently comes into contact with soil. He has autism spectrum disorder and often walks barefoot for sensory stimulation. Physical examination revealed an erythematous, serpiginous skin lesion with raised borders on the posterior right leg, accompanied by small papulovesicular lesions on the limbs (Fig. 1A–C). No additional diagnostic tests were required, given the pathognomonic lesion. The patient was discharged for outpatient follow-up and treated with oral ivermectin (200 µg/kg), once daily for 2 days and antihistamines. Two weeks posttreatment, only a residual cicatricial lesion remained (Fig. 1D), with complete resolution of pruritus.FIGURE 1.: Clinical presentation and evolution of cutaneous larva migrans and associated hookworm folliculitis. A: Serpiginous lesion on the posterior right leg on day 0 of treatment. B: Papulovesicular lesions on the left upper limb on day 0 of treatment. C: Papulovesicular lesions on the left lower limb on day 0 of treatment. D: Residual scarring on the posterior right leg, observed 15 days after treatment.Cutaneous larva migrans is a zoonotic dermatosis caused by Ancylostoma spp., endemic to tropical and subtropical regions.1 This case suggests a rare autochthonous transmission in Portugal and highlights the increasing recognition of cutaneous larva migrans in Southern Europe.2 Climate change and global migration might play a role.2 Early recognition is essential to prevent complications.1 Ivermectin is preferred due to its safety and convenient single-dose regimen, although local availability may be limited.3 ACKNOWLEDGMENTS The authors thank the patient and their family for consenting to share this case.