Lesiones petequiales periumbilicales en paciente crítica, signo a conocer por un dermatólogo

Periumbilical purpuric rash as a clue to the diagnosis of strongyloidiasis and HTLV-1 infection

“…Strongyloidiasis affects about 370 million people worldwide (Barreto et al, 2022). Its etiological agent is the nematode S. stercoralis, found in the soil as filariform larvae (Krasnovska et al, 2022). That is how, after contact, the helminth penetrates the intact skin barrier and it migrates from the venous system to the lungs and intestine.…”

“…Patients may experience intermittent diarrhea, constipation, nausea, and vomiting. In severe cases, pulmonary and neurological manifestations, ascites and bacteremia, among others, may occur (Fernandez et In these cases, cutaneous involvement is rare and, when it occurs, it usually causes an indistinct rash, urticaria, or diffuse purpuric lesions (Fernandez et al, 2016;Guerreiro et al, 2018;Krasnovska et al, 2022). Larva currens, a serpiginous, migratory, and very itchy rash, has also been described, particularly in the perianal area (Fernandez et al, 2016;Reinehr et al, 2018).…”

“…Exceptionally, as in the reported case, there may be a peculiar purpuric eruption on the abdomen. The lesions are non-palpable petechiae and purpura, with a "fingerprint" pattern, located in the periumbilical region and in the anterior portion of the thighs (Fernandez et al, 2016;Krasnovska et al, 2022). The manifestation is considered a sign of poor prognosis and it occurs due to the migration of S. stercoralis larvae from the vessel wall to the dermis, causing extravasation of red blood cells (Fernandez et al, 2016;Reinehr et al, 2018).…”

“…Early diagnosis and prompt treatment are essential for a better prognosis (Guerreiro et al, 2018;Barreto et al, 2022). For the laboratory analysis, serology, parasitological examination of feces (stool O&P test), direct observation of the helminth and DNA research may be performed (Costa et al, 2021;Krasnovska et al, 2022). Faced with the clinical suspicion of a severe condition in immunosuppressed patients, negative serology is not considered as reliable, and the analyzes must be performed on two or more stool samples, in addition to molecular tests, when available (Costa et al, 2021).…”

“…Strongyloidiasis is considered a neglected tropical disease, it is caused by the parasite Strongyloides stercoralis, a helminth that can be found in the soil, and which it has humans as its main reservoir (Guerreiro et al, 2018;Krasnovska et al, 2022). Its distribution is global, but the nematode is known to impact, in particular, tropical and subtropical countries, including Brazil, Colombia and Sub-Saharan Africa, these geographical regions is known to be hyperendemic for S. stercoralis (Barreto et al, 2022;Krasnovska et al, 2022). The disease is often asymptomatic, but some individuals may have a severe clinical condition (Fernandez et al, 2016;Barreto et al, 2022).…”