Dhir et al. Journal of Medical Case Reports 2010, 4:209 http://www.jmedicalcasereports.com/content/4/1/209 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access CCasue treaponrteous larva migrans with optic disc edema: a case report Luna Dhir*1, Tim O'Dempsey2 and Mark T Watts3 Abstract Introduction: A rare case of optic disc edema associated with cutaneous larva migrans is presented. To the best of our knowledge, this has not been previously reported in literature. Joint management by ophthalmology and tropical medicine teams proved most beneficial for our patient, facilitating correct diagnosis, appropriate investigations and instigation of suitable treatment. Case presentation: A 45-year-old Caucasian man, a naturalist, from the UK developed cutaneous larva migrans while in Kenya and presented to us with visual disturbance secondary to unilateral optic disc edema. This resolved after receiving a single dose of ivermectin and visual acuity reverted to normal. Conclusion: To the best of our knowledge, optic disc edema associated with cutaneous larva migrans has not been previously reported. This case highlights the importance of taking relevant history of recent travel to endemic areas affected by the nematodes in patients presenting with optic disc edema, and pertinent questioning regarding non- ocular symptoms, including skin lesions. In this case, a history of recent foreign travel and treatment for skin lesions was crucial. Introduction Optic disc edema associated with cutaneous larva migrans is an unusual presentation in the UK, although diffuse unilateral sub-acute neuroretinitis (DUSN) caused by a motile sub-retinal nematode has been reported in the USA, the Caribbean Islands, Brazil, Ger- many, Venezuela, Canada and China [1]. We report a case of cutaneous larva migrans associated with unilateral optic disc edema, which resolved after a single dose of ivermectin. Case presentation A 45-year-old Caucasian man from the UK was referred by his general practitioner to the ophthalmic casualty department, with a four-week history of blurred vision and floaters in the left eye, pain on ocular movement and left-sided headache. There was no previous ophthalmic history and his general health was good. Being a natural- ist, our patient had been on a two-week expedition to mangrove swamps in Kenya, and had returned six weeks * Correspondence: luna_dhir@yahoo.com 1 West of England Eye Unit, Royal Devon and Exeter Hospital, Exeter, UK Full list of author information is available at the end of the article ago. His ocular symptoms developed two weeks after his return from Kenya. He gave a history of being referred to a School of Tropi- cal Medicine by his general practitioner on his return, as he had developed skin lesions. He was seen there by appointment five weeks after his return (a week prior to presentation at the eye clinic). He was diagnosed to have cutaneous larva migrans and was treated by the tropical medicine specialist with a single oral dose of 18 mg iver- mectin. The ocular symptoms preceded the treatment with ivermectin by three weeks. Visual acuities were 6/6 in both eyes. Anterior segment, pupillary reflexes, color vision, Pelli Robson contrast sen- sitivity and Humphrey visual fields were normal. Fundus examination showed the presence of a swollen optic disc in the left eye (Figure 1). The right optic disc was normal. Physical examination revealed the presence of typical lesions of cutaneous larva migrans on arms, legs and back. Blood investigations including inflammatory mark- ers and auto antibodies were normal. Serum was negative for syphilis, toxoplasmosis, toxocara and brucellosis. Magnetic resonance imaging (MRI) of orbits and brain was normal. © 2010 Dhir et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons At- tribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.