Fatal Disseminated Strongyloidiasis with Periumbilical Purpura

A 42-year-old male patient living with HIV in northern Brazil was presented to the emergency room with a 1 -week history of dyspnea and generalized itching. He had abandoned antiretroviral therapy for 2 years. Physical examination revealed respiratory distress and hypotension. Laboratory findings included leukopenia without eosinophilia, a CD4T-helper cell count of 7 cells/uL, and an HIV viral load of 39,331,629 copies. Chest computed tomography showed diffuse ground-glass opacities. Respiratory tract polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 and Mycobacterium tuberculosis were negative. During the initial 24 hours, despite fluid resuscitation, the patient deteriorated and required vasoactive drugs and ventilatory support in the intensive care unit, where corticosteroids and sulfamethoxazole/trimethoprim were started for presumed Pneumocystis pneumonitis. During intensive care unit admission, a detailed examination of the skin revealed purplish macules and papules on the periumbilical area, abdomen, and flanks, with linear and serpiginous configurations resembling thumbprints.