Disseminated strongyloidiasis in a patient with acquired immunodeficiency syndrome

Kao, David M.F.; Murakawa, George J.; Kerschmann, Russell; Berger, Timothy G.

doi:10.1001/archderm.132.8.977

Cited by 6 publications

(1 citation statement)

References 5 publications

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“…Cutaneous purpura is a rare manifestation of hyperinfection syndrome and/or disseminated strongyloidiasis resulting from massive larval migration though intradermal vessels . A case series of 6 patients with disseminated strongyloidiasis consistently found the distribution of purpura to be around the umbilicus and on the proximal lower extremities, as in the present patient.…”

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confidence: 72%

Disseminated Strongyloidiasis

2019

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A Salvadoran man in his 60s underwent resection of a meningioma that was complicated by a postoperative brain abscess requiring highdosedexamethasone.Inthehospital,hedevelopedEscherichiacolibacteremiapresumedtobefromurinarysourceandworseningpulmonary infiltrates treated as aspiration pneumonia. Shortly after initiation of antibiotic therapy, the patient developed a purpuric eruption on his abdomen (Figure 1) and thighs with concurrent eosinophilia peaking at 2.9 × 10 9 cells/L. The presence of visible tracks on the blood agar plates led to closer inspection of the respiratory specimen and detection of Strongyloides larvae (Figure 2).Skin biopsy findings were consistent with noninflammatory purpura, with no parasites seen. Follow-up analysis of stool samples and blood tests revealed the presence of Strongyloides stercoralis. The patient was treated with a combination of oral ivermectin and albendazole for a total of 16 days. He eventually made a slow recovery after requiring rehabilitation for 2 months.Strongyloidesstercoralisisanintestinalnematodeendemictotropicalandsubtropicalregions.Filariformlarvapresentinthesoilpenetrate human skin and then travel via the lungs to the small intestine. Acute infection can result in a pruritic eruption after the larvae penetrate the skin, also known as ground itch. Larva currens is a pathognomonic skin manifestation of chronic strongyloidiasis that is characterized by rapidly progressing evanescent serpiginous tracks. The parasite can persist indefinitely in a single host through an autoinfection cycle. 1 Risk factors for hyperinfection syndrome and disseminated strongyloidiasis include any form of impaired cell-mediated immunity, with corticosteroid use constituting the most common risk factor.Cutaneous purpura is a rare manifestation of hyperinfection syndrome and/or disseminated strongyloidiasis resulting from massive larval migration though intradermal vessels. 2 A case series of 6 patients with disseminated strongyloidiasis consistently found the distribution of purpura to be around the umbilicus and on the proximal lower extremities, 3 as in the present patient. This distribution is postulated to result from larval migration through mesenteric veins into the portal circulation. 4 Positive-pressure mechanical ventilation may contribute to this finding by increasing portal pressure and portosystemic shunting through umbilical and periumbilical veins. 4 Larval migration and ulceration in the intestinal mucosa may also lead to secondary bacteremia with enteric organisms. This case illustrates the importance of obtaining a travel and exposure history, particularly in the setting of a new eruption and eosinophilia. In disseminated strongyloidiasis, delayed diagnosis contributes to its high case-fatality rate. 1 In the appropriate clinical and epidemiological context, early recognition of periumbilical purpura may improve survival for patients with disseminated disease.

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confidence: 72%

Disseminated Strongyloidiasis

2019

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Helminth

Grossman

Fox

Kovarik

et al. 2011

Cutaneous Manifestations of Infection in the Immunocompromised Host

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Cutaneous Manifestations of Selected Parasitic Infections in Western Pacific and Southeast Asian Regions

Belizario

Trinos

Garcia

et al. 2016

Curr Infect Dis Rep

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Cutaneous manifestations of parasitic infections often result in discomfort, debilitation, and even stigmatization. Data on cutaneous manifestations of parasitic infections, however, are limited. This article provides updates on the cutaneous manifestations of parasitic infections which are known to occur in Western Pacific and Southeast Asian regions, such as scabies, pediculosis, cutaneous larva migrans, larva currens, cutaneous schistosomiasis, cutaneous enterobiasis, cutaneous cysticercosis, acute dermatolymphangioadenitis (lymphatic filariasis), and cutaneous amoebiasis. The lack of epidemiological data on these conditions suggests the need for improvements in recording and reporting of cases. Utilization of advance diagnostic modalities and capacity building of health workers are important for proper case management. Cutaneous manifestations of parasitic infections are a topic rarely studied and thus represent an opportunity for further research.

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Disseminated strongyloidiasis in a patient with acquired immunodeficiency syndrome

Cited by 6 publications

References 5 publications

Disseminated Strongyloidiasis

Disseminated Strongyloidiasis

Helminth

Cutaneous Manifestations of Selected Parasitic Infections in Western Pacific and Southeast Asian Regions

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