Disseminated strongyloidiasis in immunocompromised patients - report of three cases

Background  Strongyloides stercoralis is an intestinal nematode of humans. The characteristic cutaneous manifestation of strongyloidiasis is larva currens. Patients with suppressed immunity can develop a severe disseminated strongyloidiasis involving wide spread of the larvae to extraintestinal orga...

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Bibliographic Details
Published in:International journal of dermatology 2009-09, Vol.48 (9), p.975-978
Main Authors: Galimberti, Ricardo, Pontón, Anahí, Zaputovich, Fatima Agüero, Velasquez, Lorna, Galimberti, Gaston, Torre, Ana, Kowalczuk, Alicia
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Dermatology
Diseases caused by nematodes
Female
Helminthic diseases
Humans
Immunocompromised Host
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious diseases
Male
Medical sciences
Middle Aged
Parasitic diseases
Strongyloidiasis - diagnosis
Strongyloidosis
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Summary:Background  Strongyloides stercoralis is an intestinal nematode of humans. The characteristic cutaneous manifestation of strongyloidiasis is larva currens. Patients with suppressed immunity can develop a severe disseminated strongyloidiasis involving wide spread of the larvae to extraintestinal organs, outside the usual migration pattern. Patients with cell‐mediated immunodeficiency and on corticosteroid therapy appear to be at highest risk for the development of this highly fatal entity. Methods  We present three patients with disseminated strongyloidiasis. All patients were immunocompromised and were undergoing corticosteroid therapy. Physical examination revealed a rapidly progressive purpuric petechial eruption with a reticulated pattern, mainly over the abdomen. Results  The histopathologic findings of the skin biopsies revealed a purpuric lymphomonocytic vasculitis that compromised the superficial dermis. In one skin biopsy, a larva was identified. None of our patients had eosinophilia. Strongyloides stercoralis was isolated in the fluid of the three patients, either before or after they died. Conclusion  The risk of disseminated strongyloidiasis in patients with impaired cell‐mediated immunity is unknown; however, given the poor prognosis of disseminated strongyloidiasis, consideration should be given to the screening of patients at increased risk of infection.
ISSN:0011-9059
1365-4632
DOI:10.1111/j.1365-4632.2009.04082.x