title: Cutaneous manifestation of disseminated strongyloidiasis in a patient coinfected with HTLV-I.
abstract: Strongyloidiasis is a potentially lethal parasitic infection. Coinfection of a patient with human T-lymphotropic virus type I (HTLV-I) can lead to a more severe disease course and treatment-refractoriness. Here we report a patient coinfected with HTLV-I and Strongyloides stercoralis who developed disseminated, treatment-resistant disease. The patient presented with serpiginous, nonpalpable, purpuric streaks on the abdomen and proximal lower extremities. A biopsy of this eruption demonstrating filariform larvae in the dermis was consistent with disseminated strongyloidiasis. The patient's immune dysregulation due to HTLV-I positivity likely contributed to her development of disseminated disease. Awareness of the interaction between HTLV-I and strongyloidiasis has important implications in terms of prognosis and treatment. Recognition of the cutaneous manifestations of disseminated disease can facilitate diagnosis and implementation of appropriate therapy.
authors.affiliation: Department of Dermatology, Weill Medical College of Cornell University, New York, New York, USA. eml2002@nyp.org
authors.forename: Emily L
authors.initials: EL
authors.lastname: Arch
authors.forename: Jochen T
authors.initials: JT
authors.lastname: Schaefer
authors.forename: Anjali
authors.initials: A
authors.lastname: Dahiya
mesh_terms: D000005:Abdomen; D000285:Administration, Rectal; D000328:Adult; D000818:Animals; D000977:Antiparasitic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D015490:HTLV-I Infections / Q000150:complications*; D006801:Humans; D007441:Intubation, Gastrointestinal; D007559:Ivermectin / Q000008:administration & dosage / Q000627:therapeutic use; D007866:Leg; D011693:Purpura / Q000469:parasitology*; D012867:Skin / Q000469:parasitology*; D017171:Strongyloides stercoralis / Q000302:isolation & purification; D013322:Strongyloidiasis / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000977:Antiparasitic Agents; D007559:Ivermectin