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A 19-year-old man presented with a three-week history of asymptomatic serpiginous eruptions on his neck. As a beach lifeguard in Southern California, he had no history of international travel. Physical examination revealed two raised, erythematous lesions one on the posterior neck and another on the right lateral surface. A punch biopsy showed nonspecific inflammation, and potassium hydroxide scraping was negative for fungal elements.
The patient’s occupation and morphologic characteristics of the rash suggested cutaneous larva migrans, a condition caused by skin exposure to soil or sand contaminated by cat or dog hookworm larvae. Although common among international travelers, locally acquired cases occur in warmer U.S. regions. Cutaneous larva migrans typically causes intense pruritus, resulting from larval migration through the epidermis, triggering inflammation