Bullous cutaneous larva migrans: an atypical presentation and review of literature

Abstract Cutaneous larva migrans (CLM) is a common parasitic dermatosis in tropical regions that classically presents with intensely pruritic serpiginous tracks. Atypical manifestations, including bullous lesions, may lead to diagnostic confusion and delayed treatment. We report a case of bullous CLM in a previously healthy 34-year-old man following barefoot exposure to mud during a hike in Thailand. The lesion was initially treated with antibiotics for presumed bacterial infection without improvement. Nine days after symptom onset, multiple tense bullae with surrounding erythema developed on the right foot. Review of a prior photograph demonstrating a serpiginous track, together with the exposure history, supported the diagnosis of bullous CLM. Treatment with a single oral dose of ivermectin resulted in rapid clinical improvement without recurrence. This case report aims to increase awareness of the wide spectrum of atypical presentations of CLM and highlights the diagnostic value of prior clinical photographs, detailed exposure history, and careful re-evaluation of non-resolving symptoms in avoiding delayed diagnosis and unnecessary treatment.