• Patient who commonly has to maneuver on the ground while on his back who presents with a pruritic serpiginous rash on his back and is found to have an eosinophilia, most consistent with cutaneous larva migrans (caused by Ancyclostoma or Necator hookworks)
• Ascariasis –> Bowel obstruction, biliary obstruction, eosinophilia
• Scabies –> Pruritic rash worse at night with burrows in web-spaces of fingers/toes

https://step-prep.org/tutoring/

Remember eosinophilia: DNAAACP or "D N triple A CP"

• D rugs
• N eoplasia
• A llergic
• A sthma
• A ddison's disease or A drenal insufficiency
• C onnective tissue disease (e.g., scleroderma)
• P arasite

Fire ants don't cause eosinophilia*

Ascaria is a pulmonary helminth and O and P is positive

Scabies usually in the webs of fingers and causes mite burrows and papules

Cutaneous larva migrans causes intensely pruritic serpiginous lesions anywhere that has come in contact with contaminated sand or soil

Serpiginous = hooks on your foot = hookworms

(*Or do they???

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096327/)

Its not Fire ant. because if it was he would notice instantly. Intense pain followed by intense pruritus.

Hypereosinophilic syndrome is a disease characterized by a persistently elevated eosinophil count (≥ 1500 eosinophils/mm³) in the blood for at least six months without any recognizable cause, with involvement of either the heart, nervous system, or bone marrow.[2]

HES is a diagnosis of exclusion