LAUSR

DEAR EDITOR, A 48-year-old man developed periumbilical purpura (Fig. 1a) and experienced a left frontoparietal ischaemic vascular accident. Histopathological examination revealed Strongyloides stercoralis in dermal vessels (Fig. 1b, c; original magnification 9 400, haematoxylin and eosin) and stool samples were positive for S. stercoralis. Screening for malignancies was negative and human T-lymphotropic virus 1 infection was identified. The patient was treated with ivermectin and lesions regressed. Purpura occurs because S. stercoralis larvae migrate through the vascular wall into the dermis, which causes extravasation of erythrocytes. Disseminated strongyloidiasis should be suspected in immunosuppressed patients with periumbilical petechiae and purpura. Although other cutaneous manifestations are uncommon, larva currens and weals may represent other scenarios in which the condition might be diagnosed.