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A 22-year-old Senegalese man, who had been in Italy for 2 years, in a good general state of health and with an unremarkable medical history, had been suffering for an unspecified length of time from widespread itching, along with the gradual appearance of numerous keratotic nodular lesions, sometimes interspersed with areas of lichenification in a picture of progressive xerosis ( Fig. 1). During a previous stay in our hospital department, he had suffered a serious attack of asthma, with hypereosinophilia (19%) and an increase in serologic immunoglobulin E (IgE) (2000 IU/mL).

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Figure 1. Clinical view of the lesions on the left leg

A histologic examination of a lesion removed from the patient's back revealed the presence of slight acanthosis and an inflammatory infiltrate in the surface and middle dermis, mainly consisting of lymphocytes and a few eosinophils ( Fig. 2).

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Figure 2. Histologic view of a lesion (hematoxylin and eosin, × 250)

A parasitologic examination of the feces revealed the cause of the clinical picture, and led to the identification of Strongyloides stercoralis ( Fig. 3). The patient was subjected to a short cycle of treatment with albendazole, 400 mg/day for three consecutive days.

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Figure 3. Parasite isolated from the feces (direct examination, × 100)

The patient was kept under observation for the next 6 months, and his clinical picture and symptomatology slowly but gradually improved. Examination of the feces gave a negative result.