A Salvadoran man in his 60s underwent resection of a meningioma that was complicated by a postoperative brain abscess requiring high-dose dexamethasone. In the hospital, he developed Escherichia coli bacteremia presumed to be from urinary source and worsening pulmonary infiltrates treated as aspiration pneumonia. Shortly after initiation of antibiotic therapy, the patient developed a purpuric eruption on his abdomen (Figure 1) and thighs with concurrent eosinophilia peaking at 2.9 × 109 cells/L. The presence of visible tracks on the blood agar plates led to closer inspection of the respiratory specimen and detection of Strongyloides larvae (Figure 2).
Belga S, MacDonald C, Houston S. Disseminated Strongyloidiasis. JAMA Dermatol. Published online June 12, 2019155(8):957. doi:10.1001/jamadermatol.2019.0954
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