CASE REPORT
A 66-year-old man from Guyana, who had been living in
the United States for twelve years, was treated with
prednisone 60 mg orally daily for approximately one
year, for his Pemphigus Foliaceus (biopsy and immunofluorescence
confirmed). Importantly, the patient had a baseline unexplained
anemia, and underwent esophagogastroduodenoscopy
and colonoscopy with biopsy to determine etiology of his
low red blood cell counts. These studies were negative, and he
was initiated on MMF 1 gram orally twice-daily in addition to
oral prednisone.
He was subsequently admitted to our institution complaining of
abdominal pain, nausea and diarrhea. His hospitalization was
complicated by the development of acute respiratory distress
syndrome and gram negative sepsis, requiring transfer to the intensive
care unit. The chest radiograph showed diffuse bilateral
pulmonary infiltrates and initial laboratory evaluation showed
hemoglobin of 6.0 g/dl (12.4-14.9). Ultimately, he required broad
spectrum antibiotics, multiple transfusions, and respiratory and
cardiovascular support. Three days after the admission the patient
developed numerous disseminated purpuric papules and plaques
with pink to violaceous reticulated patches over the abdomen and
thighs (Figure 1). A biopsy obtained from an abdominal lesion
showed scattered filariform larvae as well as red blood extravasation
consistent with S. stercoralis larvae, without evidence of
vasculitis (Figure 2).
The sputum cytology also showed worm larvae consistent with
SS. He was treated with daily oral doses of ivermectin 200 µg/kg
