title: Disseminated Strongyloides stercoralis: hyperinfection during medical immunosuppression.
abstract: Hyperinfection caused by Strongyloides stercoralis in iatrogenically immunosuppressed patients is becoming more frequently observed. Here, we review the relevant literature and present a recent case of hyperinfection syndrome of S stercoralis in a patient chronically treated with systemic corticosteroids and methotrexate for dermatomyositis. The patient was born in Guatemala but no history of Strongyloides infection was documented. Disseminated Strongyloides is often associated with the immunocompromised state and is commonly seen with cutaneous lesions, respiratory failure, and sepsis. In this patient, a protracted course of progressive muscle weakness and multiple hospital stays for respiratory distress led to acute respiratory failure, septic shock, and rapid physical decline. A few days preceding his death, the patient developed petechiae and multiple purpuric macules and patches over the abdomen and thighs. Histologic review of skin biopsy specimens demonstrated multiple intravascular and interstitial filariform larvae. Dermatologists should be aware of patient populations at risk for infection with S stercoralis and be able to make this diagnosis to initiate earlier treatment of hyperinfection and dissemination.
authors.affiliation: Department of Dermatology, St Joseph Mercy Hospital, Ypsilanti, Michigan, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Basile
authors.forename: Soheil
authors.initials: S
authors.lastname: Simzar
authors.forename: Jason
authors.initials: J
authors.lastname: Bentow
authors.forename: Fernando
authors.initials: F
authors.lastname: Antelo
authors.forename: Paul
authors.initials: P
authors.lastname: Shitabata
authors.forename: Shi-Kaung
authors.initials: SK
authors.lastname: Peng
authors.forename: Noah
authors.initials: N
authors.lastname: Craft
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D000818:Animals; D001706:Biopsy; D003882:Dermatomyositis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D017171:Strongyloides stercoralis / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000276:immunology* / Q000473:pathology; D015163:Superinfection / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones