Generalized serpiginous eruption during immunosuppressive treatment for leprosy reactive neuritis

Discussion This case illustrates the exuberant cutaneous manifestations of larva currens and highlights the importance of primary and secondary prophylaxis of disseminated strongyloidiasis in endemic areas during immunosuppressive treatment such as that used for organ transplantation, oncologic chemotherapy, immunologic diseases, and leprosy reactions. Key Learning Points * Presentation of disseminated larva currens as multiple pruriginous erythematous serpiginous wheals * Therapeutic immunosuppression is the trigger factor for dissemination in a patient with S. stercoralis infestation * Hyperinfection syndrome and death are possible complications of untreated cases; * Effective treatment is possible with ivermectin 200 µg/kg/day for 2 days * Differential diagnosis: cutaneous larva migrans and dermographism--both can be ruled out by detection of movement within minutes by pen markings on the extremities of the tracks on physical examination Acknowledgments The authors gratefully acknowledge the able assistance of Flávia da Graça, MD, and Roberto Bueno Filho, MD, Division of Dermatology, Hospital of Clinics, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo.