Pigmented nails and Strongyloides stercoralis infestation causing clinicalworsening in a patient treated for immunoproliferative small intestinal disease: two unusual observations

Immunoproliferative small intestinal disease (IPSID) is commonly reported f rom developing countries with poor socioeconomic conditions, hygiene, and h igh frequency of gastrointestinal infections and infestations. The disease requires anti-malignant chemotherapy in lymphomatous stage. Reported here i s a 20-year old man with IPSID lymphoma who responded to anti-malignant che motherapy initially, but later deteriorated due to Strongyloides stercorali s infestation, which was treated successfully with mebendazole, Importance of an early recognition and adequate treatment for gastrointestinal infecti ons and infestations before anti-malignant chemotherapy for this disease is highlighted considering the occurrence of this disease in the developing w orld. The patient developed alternate brown black and white lines in the fi nger nails after combination chemotherapy, which has not been reported earl ier in this disease; the nail changes disappeared 6 months after the withdr awal of doxorubicin suggesting this drug as the cause for such nail changes during anti-malignant combination chemotherapy.