Thread by @guerreroespejo

A 40-year-old woman from Brazil, AIDS, CD4 91 cells/μL: headache, diffuse cerebral edema, coma, respiratory distress, tracheal secretion with nematode
(1), alveolar hemorrhage, periumbilical purpuric rash (2), & death

🔬brain: 3
1/

doi.org/10.1093/cid/ci…
#MedEd #IDtwitter

🔬tracheal secretion: Strongyloides stercoralis (1)

Skin biopsy: S. stercoralis larvae at the dermis and hypodermis.

DISSEMINATED STRONGYLOISIASIS WITH EXTENSIVE CUTANEOUS AND CEREBRAL INVOLVEMENT
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#microbiology #MedStudentTwitter

Strongyloidiasis occurs worldwide, but predominates in tropical and subtropical areas.

People acquire the disease from penetration of larvae through the skin.
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#MedicalStudents #MedTwitter

When the host becomes immunodepressed, the autoinfection cycle is accelerated and it begins to migrate intensively to other organs besides the intestine, such as the lungs or the skin.

Disseminated strongyloidiasis, is frequently lethal despite treatment.
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#Doctor #resident

Skin involved is classically described as a petechial & purpuric rash involving the periumbilical area, also known as the “thumbprint purpura sign" (2), which some authors propose to be a pathognomonic manifestation of disseminated strongyloidiasis.
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#medicine #dermatology