Disseminated strongyloidiasis after prolonged treatment with corticosteroids

Abstract

Strongyloides stercoralis is a helminth found in the soil and transmitted to humans through larval penetration of the skin. It is endemic across most of the tropical regions of the world. Infection with S. stercoralis commonly causes minimal or mild symptoms. This case report describes an interesting final diagnosis for a woman presenting with persistent nausea, vomiting and epigastric pain. Her evaluation included imaging and oesophagogastroduodenoscopy with biopsy. Her biopsy results revealed oesophageal candidiasis and disseminated strongyloidiasis. Important historical clues in this case included previous prolonged treatment with steroids, recent diagnosis of gram-negative bacteraemia, prior residence in Rwanda, and unknown predeparture treatment for S. stercoralis. She was ultimately treated with fluconazole and ivermectin with marked improvement in her symptoms.

Fatal Disseminated Strongyloidiasis in Steroid Overuse

“…The image shows the histopathological section from the gastric biopsy specimen, revealing larval and adult forms of Strongyloides stercoralis . Disseminated strongyloidiasis is a rare infectious complication seen in immunocompromised patients uniquely on chronic steroid therapy [ 1 ]. Steroids enhance the molting of the parasite and cause dissemination, as seen in our case [ 2 ].…”

Seroprevalence and associated risk factors of strongyloidiasis in indigenous communities and healthcare professionals from Brazil

“…As important, reactivation of infection has been observed in individuals under continuous immunosuppressive treatment such as chemotherapy [ 6 ] or corticosteroids [ 7 ], and those suffering from chronic alcoholism [ 8 ], or immunosuppressed [ 9 , 10 ]. Reactivation risk, hyper-infection syndrome development, and disseminated disease have also been observed in persons with tissue transplants of both solid organs and hematopoietic stem cells [ 11 – 13 ].…”