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A Spanish man had a roundworm infection so bad that doctors could literally see the larvae slithering under his skin.

A new case study published in the New England Journal of Medicine details the 64-year-old man’s rare “hyperinfection,” which was officially diagnosed as a side effect from the Strongyloides stercoralis nematode’s larvae.

The horrific photos of the former sanitation worker’s infection look more like shoddily-done tattoos than a parasite, because his doctors drew outlines of the initial placement of the larvae just under his skin, showing that they moved over course of 24 hours.

As the NEJM notes, the Spanish patient had a number of environmental factors that made him particularly susceptible to the parasite. Along with working at a sewage management facility, he had also been diagnosed with metastatic lung cancer.

What’s more, he developed the infection in the hospital after taking a high dose of immunosuppressive glucocorticoids for a cancerous growth that was pressing on his spinal cord.

As terrifying as the whole ordeal sounds, the itchiness of the rash from the man’s infection was perhaps the worst of his symptoms, though he did also suffer a bout of what was described as “mild” diarrhea. Both symptoms cleared up after the man’s doctors prescribed him none other than ivermectin — which works well on roundworms but not, as we’ve learned, on COVID-19.

READ MORE: Larva Currens in Strongyloides Hyperinfection Syndrome [New England Journal of Medicine]

More on terrifying parasites: Doctors Alarmed to Discover Tapeworm Inside Man’s Brain


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