Strongyloides stercoralis central nervous system dissemination in a migrant misdiagnosed with eosinophilic granulomatosis with polyangiitis

Strongyloides stercoralis hyperinfection syndrome with cerebral involvement

Strongyloidiasis is a disease caused by the intestinal helminth Strongyloides stercoralis. When the immune system of infected individuals is compromised, larvae may migrate from the gastrointestinal tract to other tissues, causing S. stercoralis hyperinfection syndrome, which has a reported mortality of 71%. In this case, we report a patient with S. stercoralis hyperinfection syndrome with central nervous system (CNS) involvement. An elderly South East Asian male tourist presented with pulmonary symptoms, fever and infiltrates on chest X-ray. He later developed symptoms of CNS infection. S. stercoralis larvae were found in a stool sample. Microbiological examination of cerebrospinal fluid revealed S. stercoralis-specific DNA. The patient was treated with oral and rectal ivermectin and albendazole. The condition was complicated by sepsis, bacteraemia and hypereosinophilia. Unfortunately, the patient eventually died from pulmonary oedema and insufficiency. This case highlights the global importance of Strongyloides CNS infection in endemic and non-endemic regions.

Disseminated strongyloidiasis in a patient with rheumatoid arthritis: A case report

BACKGROUND

Strongyloidiasis is usually a chronic infection but it can develop into a fatal disease in immunosuppressed patients.

CASE SUMMARY

A 68-year-old male with rheumatoid arthritis was treated with a variety of immunosuppressants for the past 3 years. Recently, the patient presented with a partial small-bowel obstruction, petechia, coughing and peripheral neuropathy. The diagnosis was difficult to clarify in other hospitals. Our hospital found Strongyloides stercoralis larvae with active movement in the routine stool and sputum smears. The diagnosis of disseminated strongyloidiasis was established. Ivermectin combined with albendazole was used for treatment. The patient responded to therapy and was discharged.

CONCLUSION

This case underscores the importance of comprehensive differential diagnosis in immunocompromised patients.