Man’s rash caused by worms under his skin
Arash that seemed to move across a man’s entire body was due to worms crawling under his skin. The 64-yearold man, who lives in Spain, had been previously diagnosed with metastatic lung cancer and needed to be hospitalised because the cancer had spread to his spine and was pressing on his spinal cord. While in the hospital, doctors gave him a high dose of glucocorticoids, a class of steroids that fight inflammation and are sometimes used in cancer patients to help with side effects of chemotherapy and to aid in the treatment of certain cancers.
Four days after receiving the glucocorticoids, the man developed a rash in the form of red, wavy lines all over his body, along with mild diarrhoea. The man’s stool tested positive for a type of roundworm called Strongyloides stercoralis.
This roundworm is found worldwide, but is most common in the tropics, subtropics and in warm temperate regions. S. stercoralis larvae dwell in soil, so people usually become infected through contact with contaminated soil, but they can also become infected through contact with human waste or sewage. It’s unclear how the man became infected, but he worked in sewage management. When the larvae come in contact with human skin, they can penetrate it and migrate through the body to the small intestine, where they burrow and lay their eggs. The eggs hatch inside the intestine. Most of the larvae are excreted in stool, but some can re-infect a host through a process known as autoinfection.
Most people infected with S. stercoralis don’t develop symptoms, though some may develop non-specific symptoms such as abdominal pain, nausea, diarrhoea or constipation, as well as a rash where the worm entered the skin. But the infection can be life-threatening in people who take steroid medications, which suppress the immune system. The man’s treatment with glucocorticoids predisposed him to this serious form of the infection, known as strongyloides hyperinfection syndrome. In this form, the worm’s life cycle is accelerated, leading to a much higher number of worms in the body than in a regular case. The hyperinfection syndrome can also lead to the spread of the worms to lungs, liver, brain, heart and urinary tract; and can lead to death in up to 80 per cent of cases because the diagnosis often is delayed. Fortunately, the man received prompt treatment with the anti-parasitic drug ivermectin and his symptoms abated.