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 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.


CONCLUSIONS
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.
Galimberti
Ricardo
R
Department of Dermatology and School of Medicine, Hospital Italiano, Buenos Aires, Argentina. ricardo.galimberti@hospitalitaliano.org.ar
Pontón
Anahí
A
Zaputovich
Fatima Agüero
FA
Velasquez
Lorna
L
Galimberti
Gaston
G
Torre
Ana
A
Kowalczuk
Alicia
A
D000328:Adult; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D013322:Strongyloidiasis / Q000175:diagnosis*