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Journal of the American Academy of Dermatology
Volume 63, n° 5
pages 896-902 (novembre 2010)
Doi : 10.1016/j.jaad.2009.09.037
Case Reports

Disseminated Strongyloides stercoralis : Hyperinfection during medical immunosuppression
 

Amy Basile, DO, MPH a, Soheil Simzar, MD b, Jason Bentow, MD b, d, e, Fernando Antelo, MD b, d, Paul Shitabata, MD b, d, e, f, Shi-Kaung Peng, MD, PhD b, d, Noah Craft, MD, PhD, DTMH b, c, e,
a Department of Dermatology, St Joseph Mercy Hospital, Ypsilanti, Michigan 
b Division of Dermatology, Department of Medicine, Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California 
c Division of Adult Infectious Diseases, Department of Medicine, Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California 
d Department of Pathology, Harbor-University of California Los Angeles Medical Center, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California 
e Los Angeles Biomedical Research Institute, Torrance, California 
f Dermatopathology Institute, Torrance, California 

Reprint requests: Noah Craft, MD, PhD, DTMH, LA BioMed at Harbor-UCLA, 1124 W Carson St, HH1-207, Torrance, CA 90502.
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.

The full text of this article is available in PDF format.

Key words : dermatomyositis, dissemination, hyperinfection, immunosuppression, parasites, Strongyloides stercoralis



 Funding sources: None.
 Conflicts of interest: None declared.



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