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.
CONCLUSION: 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.