A 34-year-old man comes to the office during summer due to intensely pruritic lesions on his right foot. The patient has no chronic medical conditions and has never had similar symptoms before. He smokes a pack of cigarettes daily and drinks alcohol on social occasions. The patient works as a landscaper and recently went to a company barbeque lunch. His vital signs are normal. Physical examination findings are shown below. Which of the following most likely occurred before the patient developed these symptoms?

Question

A 34-year-old man comes to the office during summer due to intensely pruritic lesions on his right foot.  The patient has no chronic medical conditions and has never had similar symptoms before.  He smokes a pack of cigarettes daily and drinks alcohol on social occasions.  The patient works as a landscaper and recently went to a company barbeque lunch.  His vital signs are normal.  Physical examination findings are shown below.  Which of the following most likely occurred before the patient developed these symptoms?

Quizplus · Accepted Answer

11ec25c8_d447_44f8_bc81_f7766c380f9c_MD0003_00 Cutaneous larva migrans (CLM) is a creeping cutaneous eruption caused by dog (Ancylostoma caninum) or cat (A braziliense) hookworm larvae. Most infections are acquired from walking barefoot on contaminated sand (beaches) or soil. Humans are incidental hosts, and larvae are typically unable to penetrate the dermal basement membrane. As a result, cutaneous infection without deeper penetration is the norm. Most infections occur in the lower extremities (~70%), and symptoms usually start with a pruritic, erythematous papule at the site of larvae penetration (which may go unnoticed). Within a few days, patients develop symptoms related to larvae migration: intensely pruritic, serpiginous, reddish-brown cutaneous tracks. Although most cases resolve spontaneously after a few weeks, antihelmintics (eg, ivermectin) are usually given to aid clearance. (Choice A) Brown recluse spider bites occur most commonly on the upper arm, thorax, or inner thighs. Bites are characterized by a red plaque or papule with central clearing; some patients develop a necrotic eschar. This patient with a lower extremity, pruritic, serpiginous lesion is more likely to have CLM. (Choice B) Consumption of undercooked, contaminated pork can lead to gastrointestinal infection with the tapeworm Taenia solium. Most patients are asymptomatic, but some develop nausea, anorexia, or abdominal pain. Cutaneous manifestations are atypical. T solium eggs may pass via the fecal-oral route, causing cysticercosis. (Choice C) Urushiol is the irritant component of poison ivy, poison oak, and poison sumac. Patients often develop intensely pruritic, linear, vesicular (or plaque or bullous) lesions. This patient has a raised, serpiginous (not linear) rash with no vesicles or bullae, making CLM more likely. lesions (Choice D) Sporotrichosis is a fungal infection that can arise after exposure to decaying vegetation when gardening or landscaping. Symptoms include a nodule that usually ulcerates and drains an odorless, nonpurulent fluid. Additional nodular lesions may arise proximally along the lymphatic chain. Pruritus is usually absent or mild. Educational objective: Cutaneous larva migrans is a creeping cutaneous eruption due to dog (Ancylostoma caninum) or cat (A braziliense) hookworm larvae. Most infections arise from walking barefoot on contaminated sand or soil. Symptoms include a pruritic, papular lesion at the portal of entry and intensely pruritic, migrating, serpiginous reddish-brown tracks. Ivermectin is typically given to speed resolution and clearance.

A 34-Year-Old Man Comes to the Office During Summer Due