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Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding.

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Strongyloides hyper-infection can cause severe gastrointestinal bleeding during albendazole treatment. Vasculitis, triggered by dying worms, may contribute to bleeding, suggesting steroids could be beneficial alongside anthelmintics.

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Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Immunology

Background:

  • Strongyloides hyper-infection is a serious complication, particularly in immunocompromised patients undergoing chemotherapy for conditions like multiple myeloma.
  • Anthelmintic therapy, such as albendazole, is standard for treating strongyloidiasis.

Observation:

  • A patient with strongyloides hyper-infection developed life-threatening gastrointestinal bleeding after starting albendazole treatment.
  • Endoscopies revealed diffuse intestinal bleeding, and angiography showed micro-aneurysms in mesenteric arteries.
  • Biopsies indicated leukoclastic vasculitis developing after albendazole initiation, absent before treatment.

Findings:

  • The massive gastrointestinal bleeding during anthelmintic therapy was potentially exacerbated by vasculitis.
  • This vasculitis may be a reaction to substances released from worms killed by albendazole.
  • The findings suggest a mechanism beyond direct mucosal damage contributing to bleeding.

Implications:

  • Current guidelines recommend discontinuing steroids in parasitic infections, but this case suggests a potential benefit.
  • Steroid therapy, in conjunction with anthelmintics and supportive care, may be crucial for managing strongyloides hyper-infection-related vasculitis.
  • This approach led to cessation of bleeding and patient recovery, challenging existing treatment paradigms.