The Case of Shifting Rash Caused by Strongyloidiasis


In a peculiar and unsettling medical case, a 64-year-old man from Spain was found to have a rash that appeared to be on the move across his body, originating around his anus and shifting rapidly to other areas. This bizarre phenomenon was traced back to an unexpected and spine-chilling source – worms crawling beneath his skin. The startling revelation sheds light on a rare but disturbing condition caused by the roundworm Strongyloides stercoralis.

Understanding Strongyloidiasis1

Strongyloidiasis, caused by the nematode Strongyloides stercoralis, is a captivating yet sinister condition. This nematode, measuring up to a mere 600 µm in length, defies the naked eye, rendering its intrusion all the more insidious. The primary mode of infection is through contact with soil teeming with larvae. Upon contact with human skin, these larvae manoeuvre their way through the body, ultimately nesting in the small intestine, where they propagate their unsettling legacy.

Infiltration and Infestation2

When S. stercoralis larvae come into contact with human skin, they can penetrate it, embarking on a journey through the body until they reach the small intestine. Here, they burrow and lay their eggs, setting the stage for an unsettling parasitic invasion. The hatched larvae and excreted eggs can perpetuate the infection cycle. In most cases, infected individuals might not experience noticeable symptoms, but this man’s unique circumstances took a dire turn due to his glucocorticoid treatment, which rendered his immune system vulnerable.

Patient’s Medical History

The man was previously diagnosed with metastatic lung cancer, which had spread to his spine, resulting in pressure on his spinal cord. Hospitalized and undergoing treatment for his cancer, he was administered a potent dose of glucocorticoids, a class of steroids used to combat inflammation and manage the side effects of chemotherapy. Four days after the steroid treatment, a rash materialized on his skin, resembling red, wavy lines that seemingly shifted across his body. Alongside this eerie rash, the man experienced mild diarrhoea.

Laboratory Findings

The rash’s origin around the anus and its rapid migration to other body parts baffled doctors. Intriguingly, upon outlining the lesions with a pen, medical professionals observed that they had relocated within a mere 24 hours. This alarming discovery hinted at a chilling reality – worms were indeed crawling beneath the man’s skin.

A stool sample analysis confirmed the presence of Strongyloides stercoralis, a roundworm typically inhabiting soil. The man’s occupation in sewage management potentially exposed him to contaminated environments, raising speculation about his mode of infection.

Understanding the Case

The man’s suppressed immune system paved the way for a severe form of strongyloidiasis known as “Strongyloides hyperinfection syndrome.” In this form, the worm’s life cycle is accelerated, leading to a much higher number of worms in the body than in a regular case, according to a study.3 The consequences of this hyperinfection can be devastating, potentially spreading to vital organs like the lungs, liver, brain, heart, and urinary tract. Alarmingly, delayed diagnosis contributes to mortality rates as high as 80%.

Prompt medical intervention came to the man’s rescue as he received treatment with the antiparasitic drug ivermectin. This intervention curbed the distressing rash and diarrhoea, halting the worms’ unsettling migration and mitigating the threat they posed.

Global Patterns and Prevention

While most cases occur in warm, moist regions and are linked to agricultural activity or socioeconomic disadvantage, the infection’s reach extends beyond these boundaries. Strikingly, the nematode’s ability to exploit weakened immune systems, such as those under corticosteroid treatment, underscores the importance of vigilance and preventive measures.


  1. Parasites – Strongyloides. Available at: Accessed on: Aug 10, 2023
  2. Strongyloides stercoralis Infection. Available at: Accessed on: Aug 10, 2023
  3. Kassalik M, Mönkemüller K. Strongyloides stercoralis hyperinfection syndrome and disseminated disease. Gastroenterol Hepatol (N Y). 2011 Nov;7(11):766-8. PMID: 22298975; PMCID: PMC3264932.
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