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Imported gnathostomiasis manifesting as cutaneous larva migrans and Löffler’s syndrome
  1. William L. Hamilton1,
  2. Daniel Agranoff2
  1. 1 Acute Medical Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  2. 2 Department of Infectious Diseases, Brighton and Sussex University Hospitals, Brighton, UK
  1. Correspondence to Dr Daniel Agranoff, daniel.agranoff{at}


Here, we report an unusual case of invasive gnathostomiasis in a returning traveller, with a shifting pattern of relapsing cutaneous disease. The previously fit and well 32-year-old man first presented with serpiginous, pruriginous erythematous tracks characteristic of cutaneous larva migrans shortly after returning from South-East Asia. He was systemically well with no other symptoms. After ivermectin therapy, he re-presented with respiratory symptoms, peripheral eosinophilia and transient pulmonary infiltrates; the classic triad of Löffler’s syndrome associated with invasive helminth infection. Gnathostoma spinigerum immunoblot was positive. After a second round of ivermectin therapy his respiratory symptoms resolved, but the patient’s cutaneous disease relapsed repeatedly over months, with migratory erythematous swellings appearing and settling after a few days. He was treated with a 21-day course of albendazole and is lesion free at 40 weeks post initial presentation.

  • global health
  • infectious diseases
  • foodborne infections
  • travel medicine
  • tropical medicine (infectious disease)
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  • Contributors WLH and DA were both involved in the patient’s clinical care. DA was senior clinician. WLH and DA wrote the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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