Strongyloides hyperinfection in two patients with lymphoma, purulent meningitis, and sepsis

Strongyloides stercoralis hyperinfection syndrome is a rare complication of strongyloidiasis that occurs in immunosuppressed patients. It is caused by increasing autoinfection of the host by the nematode, leading to serious superimposed enterobacterial sepsis. Once established, it has a high fatality rate. Two cases are reported of Strongyloides hyperinfection in patients with lymphoma who presented with purulent meningitis. Both were receiving combination chemotherapy that included high-dose corticosteroids, and neither was granulocytopenic at infectious onset. The patients had respiratory insufficiency that required mechanical ventilation and serious septic episodes. Both were treated with thiabendazole, and one survived with clearance of the larvae. These cases illustrate the possibility of strongyloidiasis hyperinfection as an underlying diagnosis of purulent meningitis and serious septic episodes in lymphomatous patients. It may occur even without granulocytopenia.