[Autochthonous strongyloidosis in an 81-year-old woman]

Strongyloidosis is an parasitic disease, caused by an intestinal nematode endemic in tropic and subtropic regions. In Central Europe it occurs only sporadically. The infective larvae in the soil penetrate the human skin. Following circulation through the lungs the larvae settle in the small intestine and mature into adult worms. Chronic strongyloidosis recurring up to 15 years is possible through endogenous autoinfection. Clinical feature of the disease are gastrointestinal symptoms, hypereosinophilia and skin rashes. We describe the case of an 81-year-old woman who presented with scaly exanthema, fever and perianal fistulation. A microscopic examination of a stool sample demonstrated filariform larvae of Strongyloides stercoralis. An autochthonous mode of infection was assumed. After starting treatment with mebendazole eosinophilia and rash gradually disappeared. The laboratory finding of eosinophilia in patients with gastrointestinal symptoms or exanthema should prompt the differential diagnosis of a parasitosis. Stool examination is necessary to find rare autochthonous infections by intestinal nematodes. Pathogenesis, clinical manifestation and treatment of strongyloidosis are discussed along with the clinical picture.