Periumbilical purpura: dermatoscopic ﬁndings in
A 54-year-old male with autoimmune hemolytic anemia receiv-
ing high-dose corticosteroid therapy was hospitalized with diar-
rhea, vomiting, and lower respiratory tract symptoms. Two days
later, he evolved to respiratory insufﬁciency and developed pal-
pable purpura in the abdomen, more prominent in the periumbil-
ical region (Fig. 1). Dermatoscopy of the lesions showed
nonerythematous and nonnecrotizing homogeneous purpuric
areas, corresponding to hemorrhagic areas (Fig. 2a). A cuta-
neous biopsy was performed on a purpuric lesion. Histopatho-
logical examination revealed a neutrophilic small vessel
vasculitis, an eosinophilic inﬁltrate, and the presence of
Strongyloides stercoralis in dermal lymphatics (Fig. 2b,c).
Serum test of HTLV I and II were negative. Stool examinations
were positive for Strongyloides stercoralis, and larvae were
observed in the bronchoalveolar lavage as well. The patient
was treated with ivermectin 6 mg two tablets once daily for
22 days, until absence of larvae in stool tests and complete
remission of symptoms.
Disseminated strongyloidiasis (DS) is a helminthic infection
that occurs most frequently in immunosuppressed patients, with
high mortality rates.
Although cutaneous manifestations are
uncommon, if present, they might be relevant for the suspi-
ciousness of the condition. DS incidence is rising; most cases
are associated with the use of systemic corticosteroids or
HTLV-infected patients are at
higher risk to acquire more severe and difﬁcult to treat strongy-
loidiasis, because of the immune dysregulation caused by the
virus, for this reason HTLV serology should be performed for all
patients presenting DS.
The most common cutaneous manifestation of Strongyloides
stercoralis infection is larva currens: a linear, urticariform, and
pruritic lesion from the active penetration of larvae on the skin.
Cutaneous manifestations in disseminated strongyloidiasis
(a) Dermatoscopy of periumbilical purpura showing homogeneous purpuric areas that correspond to hemorrhagic
areas. (b, c) Histologic images showing ﬁlariform Strongiloides stercoralis larvae in the dermis (b) (HE, 9400), small vessels
neutrophilic vasculitis, and some interstitials eosinophils (c) (HE, 9100)
Clinical image showing periumbilical purpuric
International Journal of Dermatology 2018, 57, e30–e43 ª 2018 The International Society of Dermatology