Man’s 'Moving Rash' Was Caused by Worms Crawling Under His Skin in Eerie Medical Case

Left: Lesions were outlined with a pen; right: 24 hours later, lesions were found to have migrated away from their original location.Photo byNew England Journal of Medicine.

Imagine discovering that an unusual rash moving across your body is not just a skin issue but is caused by live worms crawling underneath your skin. This bizarre reality was reported in a case report published in The New England Journal of Medicine in 2022, involving a 64-year-old man in Spain.

The man’s symptoms began after receiving treatment for metastatic lung cancer, only to later discover that parasitic roundworms were the culprits behind his terrifying condition.

A Cancer Patient’s Unlikely Battle with Worms

The man had been hospitalized for advanced lung cancer that had spread to his spine, putting pressure on his spinal cord. As part of his treatment, he was administered high doses of glucocorticoids, powerful steroids used to reduce inflammation and help manage cancer symptoms.

But just four days into his treatment, he developed a peculiar rash, marked by red, wavy lines crisscrossing his body. What made the rash particularly unsettling was that it appeared to be "shifting" or migrating to different areas of his skin.

Doctors in Madrid described how the rash began near his anus and quickly spread to his torso and limbs. To investigate further, they outlined the lesions with a pen and, after 24 hours, confirmed that the marks had indeed moved—indicating something alive was beneath his skin.

The Diagnosis: Roundworm Infection

Tests soon revealed the man was infected with Strongyloides stercoralis, a type of roundworm most commonly found in tropical and subtropical regions.

According to the Centers for Disease Control and Prevention (CDC), this parasitic worm typically resides in soil and infects humans through skin contact, often by stepping on contaminated ground.

Once in the body, the larvae travel to the small intestine, where they mature, lay eggs, and continue their life cycle. While most of the larvae are excreted in feces, some can remain within the host, leading to what is known as "autoinfection."

In this case, the larvae penetrated the man's skin around the anus and began migrating through his body, causing the distinctive red streaks that alarmed doctors.

While many people infected with S. stercoralis remain asymptomatic, others experience mild symptoms like diarrhea, nausea, or skin rashes. But for patients like this man—whose immune systems are suppressed due to steroid treatment—the infection can escalate into something far more dangerous.

Hyperinfection: A Deadly Twist

The man’s use of glucocorticoids had set the stage for a condition known as "strongyloides hyperinfection syndrome."

This accelerated life cycle of the worm leads to a much larger population of worms inside the body. The worms can spread rapidly to vital organs such as the lungs, liver, brain, and even the heart. Left untreated, this condition has an 80% mortality rate, as diagnosing it is often delayed until it’s too late.

Hyperinfection can lead to severe complications, including respiratory failure, sepsis, and organ failure. In a study published in Gastroenterology & Hepatology, researchers emphasized the high risks posed by this syndrome, particularly for people on immunosuppressive therapies like the man in Spain.

A Timely Intervention

Fortunately, this patient received a prompt diagnosis, which allowed doctors to treat him with ivermectin, a powerful antiparasitic medication. Following the treatment, his rash and diarrhea gradually subsided, preventing what could have been a fatal progression of the disease.

The Takeaway

This rare case serves as a reminder of the dangers posed by parasitic infections, particularly in individuals with compromised immune systems. While Strongyloides stercoralis infections are relatively rare in many parts of the world, the risk remains significant in areas where contact with contaminated soil or sewage is common, as was the case for this man, who worked in sewage management.

For those taking immunosuppressive medications like glucocorticoids, extra caution must be exercised, as even a seemingly mild infection can spiral into a life-threatening situation. Thankfully, with early detection and effective treatment, this man’s story has a relatively happy ending. However, it underscores the importance of global health awareness and the ongoing battle against parasitic diseases.