Rapid development of migratory, linear, and serpiginous lesions in association with immunosuppression.
A 78-year-old Bulgarian woman presented to the National Institutes of Health (NIH) with a diagnosis of poorly differentiated metastatic carcinoma of unknown origin. The prior month she had been seen at a hospital in Bulgaria for weight loss and a right inguinal mass. NIH pathology review confirmed a poorly differentiated carcinoma with extensive necrosis suggesting squamous cell carcinoma. She was enrolled in a treatment trial at NIH with metastatic disease invading the lungs and lymph nodes (mediastinum, abdomen, and pelvis) and a chemotherapy regimen was started of gemcitabine, carboplatin, and lenalidomide with dexamethasone as an antiemetic. The patient returned on day 8, and a rash of 2 days duration was noted. Immediately before arriving at the dermatology clinic, she developed altered mental status with aphasia and was admitted for neurologic observation. The altered mental status resolved and evaluation revealed only small-vessel ischemia. The patient was also experiencing diarrhea and was found to have elevated transaminases (4- to 7-fold over normal). Chemotherapy was held because of the transaminase abnormalities and altered mental status. The following day, the patient was seen by dermatology for a progressive asymptomatic eruption.
Department of Dermatology, Georgetown University Hospital, Washington, District of Columbia.
Dominique C
DC
Pichard
Department of Dermatology, Georgetown University Hospital, Washington, District of Columbia.
Jennifer R
JR
Hensley
Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland.
Esther
E
Williams
Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Andrea B
AB
Apolo
Eosinophil Pathology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.
Amy D
AD
Klion
DNA Repair Section, Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: jdg@nih.gov.
John J
JJ
DiGiovanna
D000368:Aged; D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000276:immunology / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D007559:Ivermectin / Q000627:therapeutic use; D009382:Neoplasms, Unknown Primary / Q000276:immunology / Q000473:pathology*; D018570:Risk Assessment; D012876:Skin Diseases, Parasitic / Q000175:diagnosis* / Q000188:drug therapy; D012878:Skin Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000556:secondary*; D017171:Strongyloides stercoralis / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000175:diagnosis* / Q000188:drug therapy; D015163:Superinfection / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D056164:Teaching Rounds; D016896:Treatment Outcome
D007559:Ivermectin
Strongyloides stercoralis; autoinfection; hyperinfection; immunosuppression; ivermectin; larva currens; larva migrans; nematode; roundworm; strongyloidiasis