A 58 year old male from Ecuador presented withlarge violaceous purpura and numerous petechiae without surrounding erythema or targetoid on lower chest, abdomen and groin.

    Dr. Ekladous, a 4th year Pathology resident at Miller School of Medicine, Univ of Miami, is presenting this case report.

     

    Clinical History:

     A 58 year old male from Ecuador with a history of Laennec’s cirrhosis, status post orthotopic liver transplant, diabetes mellitus type 2, latent tuberculosis and history of a positive strongyloides serology in the past treated with a single dose of ivermectin. The patient is critically ill, with pneumonia, intubated and with bacteremia due to Escherichia coli. Dermatology was consulted for large violaceous purpura and numerous petechiae without surrounding erythema or targetoid on lower chest, abdomen and groin. No palpable lesions are appreciated. Under the clinical impression of strongyloides vs. purpura vs. LCV vs. meningococcemia, a skin punch biopsy from abdomen lesions was performed.

    Histology:

    Histological sections showed Strongyloides stercoralis larva, found mainly in both dermis and subcutaneous adipose tissue. It also showed intravascular fibrin thombi in a few small dermal vessels and changes consistent with an urticarial dermatitis, which could represent a dermal hypersensitivity reaction to the parasite. Direct immunofluorescence showed C3 deposit in several upper and mid dermal small vessels. Given the clinical history, the DIF and overall HE histology, a diagnosis of cutaneous strongyloidiasis (disseminated strongyloidiasis), was rendered.

    Diagnosis:

    Cutaneous strongyloidiasis (Disseminated strongyloidiasis).

    Conference: