This disease represents massive infection by the nematode, Strongyloides stercoralis, in an immunocompromised host. Strongyloidiasis does occur in the US and in many parts of the world. Strongyloides stercoralis may also cause larva currens.


Multiple purpuric lesion radiating out from the umbilicus like thumbprints in an immunocompromised host is characteristic. A diffuse petechial eruption may occur or be the initial finding.


The diagnosis is often made by identifying the strongyloides larvae in feces or respiratory secretions. In rare cases, the filariform larvae may be seen in the superficial reticular dermis of a biopsy specimen. A serologic test for Strongyloides IgG antibodies is available.


Thumbprint sign JAAD June 2015 Volume 72, Issue 6, Pages 1066–1073

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