Nephrotic Syndrome in Strongyloidiasis: Remission after Eradication with Anthelmintic Agents

Abstract

Strongyloides stercoralis infection is known to be important because of its potential for life-threatening disseminated infection in immunosuppressed hosts. Apart from direct invasion into nearly every organ in systemic infection, evidence suggests that immunological reaction also plays a role in the pathogenesis of the disease, including both uncomplicated and disseminated infections. However, Strongyloides-related glomerulonephritis has not been well documented. We present a case of steroid- and cyclophosphamide-resistant nephrotic syndrome complicated by disseminated strongyloidiasis which responded to anthelmintic agents. The remission of nephrotic syndrome after treatment of Strongyloides infection strongly suggests the possibility of Strongyloides-associated glomerulonephritis. Nephrotic patients in endemic areas of Strongyloides infection should have the differential white cell count checked. Strongyloides infection should be ruled out in patients with eosinophilia before immunosuppressants are initiated to prevent the complication of disseminated strongyloidiasis.

Strongyloides stercoralisin the Immunocompromised Population

“…Pruritus ani and dermatologic manifestations such as urticaria and larva currens rashes are also common (89). Recurrent asthma (73,109,124) and nephrotic syndrome (133) have also been associated with chronic strongyloidiasis infection.…”

“…Unexpected diagnoses have even been made from ascitic fluid (61) and blood smears (133). The real challenge is screening patients prior to and during immunosuppressive therapy.…”

Minimal change nephrotic syndrome in a patient with strongyloidiasis

“…In immunocompromised individuals carrying S. stercoralis, strongyloidiasis develops as a serious opportunistic infection, causing diverse symptoms [2]. Only 15 cases of nephropathy associated with S. stercoralis infection have been reported [3][4][5][6][7][8][9][10][11][12][13]. Some investigators have reported that S. stercoralis infection is involved in the onset of nephropathy, particularly minimal change nephrotic syndrome [3,4].…”

Rapidly Deteriorating Kidney Function in a Young Man Previously Diagnosed with Membranous Nephropathy

“…He had a quite high eosinophil count, suggesting that a particularly intense immunological reaction was taking place. Giardiasis may, or may not, evolve with eosinophilia and other parasitic infections, such as strongyloidiasis, should not be discarded [25] . However, association between G. lamblia infection and nephrotic syndrome has recently been suggested [26] .…”