Chronic strongyloidiasis: a case of B symptoms and recurrent asthma exacerbations

Strongyloidiasis is one of the neglected helminths infection that is often underdiagnosed and undertreated. Due to its variable presentation, its diagnosis is often a challenge. We report a case of an immigrant patient with asthma who later developed eosinophilia. After 3 years of unexplained eosinophilia, he developed B symptoms and had frequent asthma exacerbations. He was later diagnosed with strongyloidiasis and treated with ivermectin. His B symptoms resolved, and his asthma exacerbations decreased significantly. Due to the frequent use of corticosteroids in asthma exacerbations, this case illustrates the importance of Strongyloides screening in asthmatics from high-risk regions. It also displays the importance of further investigating patients with asthma who develop eosinophilia and have frequent exacerbations while on optimal asthma treatment. Having a high index of suspicion is essential when making this diagnosis, as clinical presentation is often variable and does not follow a standard time course.