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[Strongyloidiasis following long-term corticosteroid therapy].
Nihon Kyobu Shikkan Gakkai Zasshi
|October 1, 1989
Summary
Long-term corticosteroid therapy in a patient with Strongyloides stercoralis led to hyperinfection syndrome. This case highlights the risks of immunosuppression in nematode infections, even with prior treatment.
Area of Science:
- Infectious Diseases
- Pulmonology
- Gastroenterology
Background:
- Strongyloides stercoralis is a nematode with complex life cycle and potential for autoinfection.
- Corticosteroid therapy can lead to immunosuppression, increasing the risk of parasitic infections and hyperinfection syndrome.
Observation:
- A 64-year-old man presented with dyspnea and pulmonary cysts, initially treated with corticosteroids.
- Epigastric pain developed, and gastro-endoscopy revealed Strongyloides stercoralis larvae in gastric mucosa.
- Larvae were also detected in sputum and stool, indicating disseminated infection.
Findings:
- The patient developed Strongyloides stercoralis hyperinfection syndrome.
- Despite initial treatment with pyrvinium pamoate and subsequent thiabendazole, larvae persisted.
- Long-term corticosteroid use was implicated as the cause of hyperinfection in a previously auto-infected individual.
Implications:
- This case underscores the critical need to consider Strongyloides stercoralis in patients on long-term corticosteroids presenting with respiratory or gastrointestinal symptoms.
- Prompt diagnosis and aggressive treatment are essential to manage hyperinfection syndrome.
- Awareness of potential nematode reactivation under immunosuppression is crucial for clinicians.