PMC8449725_01
Imaging findings. (a) Cerebral MRI (axial, T2/FLAIR) showing cerebral edema compressing ventricles and gadolinium-enhancing T2/FLAIR white matter and basal ganglia hyperintensity, evoking acute necrotizing encephalopathy. (b) Chest CT scan showing bilateral ground-glass opacities.
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T2/FLAIR white matter and basal ganglia hyperintensity, revealing acute necrotizing encephalopathy (ANE) (Figure 1(a)). The day after ICU admission, immune status checking revealed HTLV-1 seropositivity. Chest CT scan showed bilateral ground-glass opacities (Figure 1(b)).
Histological examination showing Strongyloides stercoralis larvae. (a) Duodenal biopsy: duodenal crypts distended by numerous larvae and adult worms. (b) Purpuric lesion transcutaneous biopsy: deep dermis location of filariform larvae between collagen bundles. (c) Bronchoalveolar aspiration: inflammation and filariform larvae.
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The access to GP's investigations revealed untreated S. stercoralis infection diagnosed by duodenal biopsy 2 months before (Figure 2(a)). Punch biopsy of this rash confirmed parasitic chronic infection, showing filariform larvae between collagen bundles in the dermis (Figure 2(b)). Numbers of larvae of S. stercoralis in bronchoalveolar lavage were detected (Figure 2(c)).
Abdominal physical examination showing periumbilical purpuric lesions.
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A periumbilical, extending to the flanks, purpuric rash appeared after admission (Figure 3).