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Clinical Report: Transitioning from Chronic Infection to Disseminated Strongyloidiasis

Overview

This case study details the progression of Strongyloides stercoralis infection in a 73-year-old female patient, highlighting the diagnostic challenges. The patient transitioned from an initial misdiagnosis to severe hyperinfection syndrome, ultimately requiring anthelmintic treatment for recovery.

Background

Strongyloides stercoralis is a parasitic nematode that can lead to severe hyperinfection syndrome, particularly in immunocompromised individuals. Early diagnosis is critical, as symptoms can be nonspecific and mimic other conditions, leading to delays in appropriate treatment.

Data Highlights

The patient presented with a 30-year history of bronchial asthma, developed hyperinfection syndrome after corticosteroid therapy, and exhibited initial symptoms of cutaneous petechiae and pruritus. Diagnosis of S. stercoralis was confirmed through detection in multiple body fluid specimens. The patient required discontinuation of corticosteroids and administration of albendazole for recovery.

Key Findings

• The patient had a 30-year history of bronchial asthma and developed hyperinfection syndrome after corticosteroid therapy.

• Initial symptoms included cutaneous petechiae and pruritus, leading to a misdiagnosis of allergic purpura.

• Diagnosis of S. stercoralis was confirmed through detection in multiple body fluid specimens.

• Discontinuation of corticosteroids and administration of albendazole were critical for the patient's recovery.

• Diagnostic challenges included the dissociation between leukocytosis and eosinopenia during hyperinfection syndrome.

Clinical Implications

Healthcare providers should maintain a high index of suspicion for strongyloidiasis in patients with epidemiological risk factors, especially before initiating corticosteroid therapy.

Conclusion

This case underscores the importance of early diagnosis and the risks associated with corticosteroid use in patients with chronic strongyloidiasis. Timely intervention can lead to favorable outcomes in severe cases.

Related Resources & Content

1. CDC, Clinical Overview of Strongyloides, 2026 -- Strongyloides Overview

2. CDC, Clinical Care of Strongyloides, 2024 -- Strongyloides Clinical Care

3. Infection, Strongyloides infection occurring during immunosuppressive treatment for pneumonia caused by SARS-CoV-2, 2020 -- Strongyloides and SARS-CoV-2

4. Infection, Infection with Strongyloides stercoralis: A Potential Contributing Factor to Invasive Bacterial Enteric Infections, 2023 -- Strongyloides and Bacterial Infections

5. Infection, Management of Paradoxical Inflammatory Responses in Pulmonary Tuberculosis Patients Using Corticosteroid Therapy, 2020 -- Corticosteroids in TB

6. The Journal of Clinical Endocrinology & Metabolism — Management Strategies for Patients Experiencing Cyclical Cushing Syndrome

7. WHO guideline on preventive chemotherapy for public health control of strongyloidiasis

8. Clinical Overview of Strongyloides | Strongyloides | CDC

9. Clinical Care of Strongyloides | Strongyloides | CDC

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