Rapid development of migratory, linear, and serpiginous lesions in association with immunosuppression - 14/05/14
Doi : 10.1016/j.jaad.2013.11.036
Dominique C. Pichard, MD a, Jennifer R. Hensley, MD a, Esther Williams, BS b, Andrea B. Apolo, MD c, Amy D. Klion, MD d, John J. DiGiovanna, MD e, ⁎ 
a Department of Dermatology, Georgetown University Hospital, Washington, District of Columbia
b Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
c Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
d Eosinophil Pathology Unit, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
e DNA Repair Section, Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
∗Correspondence to: John J. DiGiovanna, MD, DNA Repair Section, Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, Bethesda, MD 20892.
Abstract |
Key teaching points |
• | Strongyloides is a genus of obligate gastrointestinal nematodes (roundworms) of vertebrates. The species stercoralis, the usual cause of human infection, has the potential for autoinfection and multiplication in human beings. |
• | Peripheral eosinophilia without a known cause may represent chronic, persistent infection with Strongyloides stercoralis. |
• | Undiagnosed disease is prevalent, especially among immigrants and military veterans who served in highly endemic areas in the tropics and subtropics. |
• | Immunosuppression of individuals with persistent Strongyloides stercoralis infection can lead to hyperinfection syndrome or disseminated infection, which can be fatal in up to 90% of cases. |
• | First-line therapy for acute and chronic strongyloidiasis is ivermectin, 200 μg/kg orally in a single daily dose for 1 to 2 days. Treatment of hyperinfection syndrome includes reduction of immunosuppression, if possible, and administration of ivermectin (200 μg/kg daily) until larvae are no longer detected in stool for at least 2 weeks.3, 17 The spectrum of clinical disease is wide, however, and shorter courses of ivermectin may be sufficient. |
• | Larva currens is a hypersensitivity reaction that refers to the cutaneous manifestation of Strongyloides and should be distinguished from cutaneous larva migrans, which is caused by abortive human infection with an animal hookworm. |
Key words : autoinfection, hyperinfection, immunosuppression, ivermectin, larva currens, larva migrans, nematode, roundworm, Strongyloides stercoralis, strongyloidiasis
Plan
| Supported by the Intramural Research Program of the National Cancer Institute, National Institutes of Health. |
|
| Conflicts of interest: None declared. |
|
| Reprints not available from the authors. |
© 2014
American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 70 - N° 6
P. 1130-1134 - juin 2014 Retour au numéro
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