RESUMEN
Periumbilical parasitic thumbprint purpura may be a presenting sign of hyperinfection strongyloidiasis in the immunocompromised host. We report a case of fatal hyperinfection strongyloidiasis acquired from a cadaveric renal allograft, diagnosed by the pathognomonic periumbilical thumbprint purpuric eruption, confirmed by skin biopsy and laboratory testing.
Asunto(s)
Cadáver , Trasplante de Riñón/efectos adversos , Riñón/parasitología , Púrpura/parasitología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/parasitología , Anciano , Animales , Biopsia , Resultado Fatal , Humanos , Masculino , Púrpura/diagnóstico , Púrpura/patología , Piel/parasitología , Piel/patología , Enfermedades Cutáneas Vasculares/parasitología , Enfermedades Cutáneas Vasculares/patología , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/patología , Síndrome , Donantes de TejidosAsunto(s)
Púrpura/parasitología , Piel/parasitología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/parasitología , Animales , Antinematodos/uso terapéutico , Biopsia , Resultado Fatal , Humanos , Ivermectina/uso terapéutico , Masculino , Persona de Mediana Edad , Púrpura/diagnóstico , Púrpura/tratamiento farmacológico , Piel/patología , Strongyloides stercoralis/efectos de los fármacos , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/tratamiento farmacológico , Factores de Tiempo , Resultado del TratamientoRESUMEN
Strongyloidiasis is a potentially lethal parasitic infection. Coinfection of a patient with human T-lymphotropic virus type I (HTLV-I) can lead to a more severe disease course and treatment-refractoriness. Here we report a patient coinfected with HTLV-I and Strongyloides stercoralis who developed disseminated, treatment-resistant disease. The patient presented with serpiginous, nonpalpable, purpuric streaks on the abdomen and proximal lower extremities. A biopsy of this eruption demonstrating filariform larvae in the dermis was consistent with disseminated strongyloidiasis. The patient's immune dysregulation due to HTLV-I positivity likely contributed to her development of disseminated disease. Awareness of the interaction between HTLV-I and strongyloidiasis has important implications in terms of prognosis and treatment. Recognition of the cutaneous manifestations of disseminated disease can facilitate diagnosis and implementation of appropriate therapy.
Asunto(s)
Infecciones por HTLV-I/complicaciones , Púrpura/parasitología , Piel/parasitología , Strongyloides stercoralis , Estrongiloidiasis/complicaciones , Abdomen , Administración Rectal , Adulto , Animales , Antiparasitarios/administración & dosificación , Antiparasitarios/uso terapéutico , Femenino , Humanos , Intubación Gastrointestinal , Ivermectina/administración & dosificación , Ivermectina/uso terapéutico , Pierna , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Cutaneous manifestations in disseminated strongyloidiasis are infrequent but should raise the suspicion for its diagnosis. We retrospectively evaluated the charts of six patients with cancer and a proven diagnosis of disseminated strongyloidiasis. All patients had received prophylaxis with albendazole before starting antineoplastic therapy, which included high-dose steroids. They presented with septic shock, acute respiratory failure and characteristic purpuric periumbilical skin lesions. Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support.
Asunto(s)
Neoplasias/patología , Neoplasias/parasitología , Púrpura/patología , Enfermedades Cutáneas Parasitarias/patología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/patología , Adulto , Anciano , Animales , Antihelmínticos/uso terapéutico , Biopsia , Resultado Fatal , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Neoplasias/inmunología , Púrpura/inmunología , Púrpura/parasitología , Piel/parasitología , Piel/patología , Enfermedades Cutáneas Parasitarias/complicaciones , Estrongiloidiasis/complicaciones , Estrongiloidiasis/tratamiento farmacológicoRESUMEN
The association of systemic corticosteroid therapy and dissemination of Strongyloides stercoralis has been increasingly documented in the literature. Skin involvement in disseminated strongyloidiasis has been reported and the most commonly described cutaneous manifestations are rash and petechial eruptions. We present a case of an immunosuppressed man that developed disseminated strongyloidiasis with extensive purpura.
Asunto(s)
Púrpura/parasitología , Strongyloides stercoralis , Estrongiloidiasis/complicaciones , Corticoesteroides/uso terapéutico , Adulto , Animales , Antinematodos/uso terapéutico , Humanos , Huésped Inmunocomprometido , Masculino , Miastenia Gravis/tratamiento farmacológico , Púrpura/patología , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/tratamiento farmacológico , Tiabendazol/uso terapéuticoRESUMEN
Congenital toxoplasmosis secondary to maternal primary infection acquired late during pregnancy is generally asymptomatic at birth. We report a case of a newborn infant whose mother had been infected between the 27th and the 33rd week of gestation. No treatment had been given during gestation. The infant had a disseminated form of toxoplasmosis with hepatosplenomegaly, pneumonitis, purpura, hepatitis. On the third day of life, he developed shock. The patient died early despite therapy. Septic shock is unusual in congenital toxoplasmosis, although it has been described in immunocompromised patients, notably in patients infected with the human immunodeficiency virus.
Asunto(s)
Choque Séptico/parasitología , Toxoplasmosis Congénita/complicaciones , Resultado Fatal , Femenino , Fluidoterapia , Hepatitis/parasitología , Hepatomegalia/parasitología , Ventilación con Chorro de Alta Frecuencia , Humanos , Huésped Inmunocomprometido , Recién Nacido , Transfusión de Plaquetas , Neumonía/parasitología , Púrpura/parasitología , Choque Séptico/terapia , Esplenomegalia/parasitología , Trombocitopenia/parasitología , Toxoplasmosis Congénita/diagnóstico , Toxoplasmosis Congénita/inmunologíaAsunto(s)
Eosinofilia/parasitología , Púrpura/parasitología , Toxocariasis/complicaciones , Toxocariasis/diagnóstico , Albendazol/uso terapéutico , Animales , Antihelmínticos/uso terapéutico , Preescolar , Diagnóstico Diferencial , Humanos , Masculino , Toxocara canis , Toxocariasis/tratamiento farmacológicoAsunto(s)
Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Púrpura/parasitología , Síndrome de Dificultad Respiratoria/parasitología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/diagnóstico , Anciano , Animales , Resultado Fatal , Humanos , Masculino , Púrpura/complicaciones , Púrpura/diagnóstico , Púrpura/inmunología , Síndrome de Dificultad Respiratoria/complicaciones , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/inmunología , Estrongiloidiasis/complicaciones , Estrongiloidiasis/inmunologíaAsunto(s)
Púrpura/parasitología , Estrongiloidiasis/complicaciones , Estrongiloidiasis/diagnóstico , Ombligo , Anciano de 80 o más Años , Animales , Antiparasitarios/uso terapéutico , Biopsia , Resultado Fatal , Humanos , Ivermectina/uso terapéutico , Masculino , Piel/parasitología , Piel/patología , Strongyloides/aislamiento & purificación , Estrongiloidiasis/tratamiento farmacológicoAsunto(s)
Glucocorticoides/administración & dosificación , Huésped Inmunocomprometido , Púrpura/patología , Púrpura/parasitología , Strongyloides stercoralis , Estrongiloidiasis/patología , Animales , Femenino , Glucocorticoides/efectos adversos , Humanos , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/inmunología , Enfermedad Pulmonar Obstructiva Crónica/patología , Estrongiloidiasis/etiología , Estrongiloidiasis/terapiaRESUMEN
A case of disseminated S stercoralis is an immunosuppressed patient manifested with diarrhea, a rash, and progressive respiratory insufficiency. The parasites were eradicated with thiabendazole despite continued steroid therapy, and the patient survived the hospitalization. The characteristics of S stercoralis allow it to be harbored within a host for prolonged periods of time, only to disseminate once cell-mediated immunity is suppressed. A diagnosis of strongyloidiasis should be considered in an immunocompromised patient with a petechial rash. Prompt diagnosis and initiation of thiabendazole therapy provides the greatest opportunity for patient survival. Secondary bacterial infections should be aggressively sought. Mortality from disseminated strongyloidiasis approaches 80%.
Asunto(s)
Enfermedades Gastrointestinales/parasitología , Complicaciones Posoperatorias , Strongyloides stercoralis , Estrongiloidiasis , Anciano , Animales , Neoplasias Encefálicas/cirugía , Cardiomegalia/parasitología , Craneotomía , Femenino , Glioblastoma/cirugía , Humanos , Terapia de Inmunosupresión/efectos adversos , Kentucky , Púrpura/parasitología , Infecciones del Sistema Respiratorio/parasitología , Enfermedades Cutáneas Infecciosas/parasitología , Esputo/parasitología , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/tratamiento farmacológico , Estrongiloidiasis/patología , Tiabendazol/uso terapéuticoRESUMEN
A infecção pelo Strongyloides stercoralis em associação com imunosupressão pode manifestar-se com lesões em múltiplos órgãos e sistemas, caracterizando a forma disseminada da doença. Lesões cutâneas não são freqüentemente relatadas e, se presentes, manifestam-se como rash e petéquias. Púrpuras bem definidas são pouco descritas. No presente trabalho é descrito um caso de estrongiloidíase disseminada, com acometimento cutâneo em forma de púrpura, que se desenvolveu em um paciente timectomizado e usuário crônico de corticosteróide devido à miastenia gravis.
Asunto(s)
Humanos , Animales , Masculino , Adulto , Antinematodos/uso terapéutico , Púrpura/parasitología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/complicaciones , Tiabendazol/uso terapéutico , Huésped Inmunocomprometido , Púrpura/patología , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/tratamiento farmacológicoRESUMEN
Cutaneous manifestations in disseminated strongyloidiasis are infrequent but should raise the suspicion for its diagnosis. We retrospectively evaluated the charts of six patients with cancer and a proven diagnosis of disseminated strongyloidiasis. All patients had received prophylaxis with albendazole before starting antineoplastic therapy, which included high-dose steroids. They presented with septic shock, acute respiratory failure and characteristic purpuric periumbilical skin lesions. Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support.