Question: Infection with this organism can lead to the serpiginous or urticarial rash in the image above. (Hints: peripheral eosinophilia may be present, may check for this in someone starting glucocorticoids based on risk factors)
Answer: Strongyloides which is caused by infection with the helminth, Strongyloides stercoralis. The most common mode of transmission is when the skin comes in contact with contaminated soil. Acute infection may involve skin irritation at site of skin penetration of larvae, urticaria/edema, cough and subsequently GI symptoms such as diarrhea, constipation, abdo pain or anorexia. Patients who are immunosuppressed are at risk for more severe disease (hyperinfection, disseminated infection).
References:
- Puerta-Peña, M., & Calleja Algarra, A. (2022). Larva Currens in Strongyloides Hyperinfection Syndrome. The New England journal of medicine, 386(16), 1559. https://doi-org.myaccess.library.utoronto.ca/10.1056/NEJMicm2115708 – Link here https://www.nejm.org/doi/full/10.1056/NEJMicm2115708
- Strongyloidiasis. UpToDate.