A Rare Case of Cutaneous Strongyloidiasis in an Immunocompromised Patient: Clinical Insights and Implications.

Abstract

Background: Strongyloides stercoralis (S. stercoralis) is a soil-transmitted nematode endemic to tropical and subtropical regions. While infections often remain asymptomatic in immunocompetent individuals, they can progress to hyperinfection or disseminated disease in immunocompromised hosts, particularly those receiving corticosteroid therapy. Disseminated strongyloidiasis is associated with a high mortality rate if not promptly diagnosed and treated.

Case presentation: We present the case of a 45-year-old woman from northern Iran with a long-standing history of corticosteroid use for rheumatoid arthritis, who developed a non-healing ulcer on her back accompanied by gastrointestinal symptoms including vomiting, nausea, loss of appetite and diarrhea. Laboratory investigations confirmed the presence of S. stercoralis larvae in both stool specimens and a skin biopsy. Stool examination was performed using the stool culture method, and the biopsy was obtained from the lesion site. The patient was treated successfully with a combination of thiabendazole and ivermectin, leading to complete resolution of both cutaneous and gastrointestinal manifestations.

Conclusion: This case underscores the importance of considering cutaneous strongyloidiasis in immunosuppressed patients, especially in endemic regions. Early recognition and prompt anti-parasitic therapy are critical for preventing severe complications and improving clinical outcomes.