Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?
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.
Salluh
Jorge I F
JI
Intensive Care Unit, National Institute of Cancer, Praca Cruz Vermelha 23, Rio de Janeiro, RJ, Brazil. jorgesalluh@yahoo.com.br
Bozza
Fernando A
FA
Pinto
Tatiana S
TS
Toscano
Luisa
L
Weller
Peter F
PF
Soares
Marcio
M
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*
D000871:Anthelmintics