title: Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?
abstract: Cutaneous manifestations in disseminated strongyloidiasis are infrequent but should raise the suspicion for its diagnosis. We retrospectively evaluated the charts of six patients with cancer and a proven diagnosis of disseminated strongyloidiasis. All patients had received prophylaxis with albendazole before starting antineoplastic therapy, which included high-dose steroids. They presented with septic shock, acute respiratory failure and characteristic purpuric periumbilical skin lesions. Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support.
authors.affiliation: Intensive Care Unit, National Institute of Cancer, Praca Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil. jorgesalluh@yahoo.com.br
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Bozza
authors.forename: Tatiana S
authors.initials: TS
authors.lastname: Pinto
authors.forename: Luisa
authors.initials: L
authors.lastname: Toscano
authors.forename: Peter F
authors.initials: PF
authors.lastname: Weller
authors.forename: Marcio
authors.initials: M
authors.lastname: Soares
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D001706:Biopsy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000276:immunology / Q000469:parasitology* / Q000473:pathology*; D011693:Purpura / Q000276:immunology / Q000469:parasitology / Q000473:pathology*; D012867:Skin / Q000469:parasitology / Q000473:pathology; D012876:Skin Diseases, Parasitic / Q000150:complications / Q000473:pathology*; D017171:Strongyloides stercoralis / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*
chemical_list: D000871:Anthelmintics