Pulmonary thromboembolism-a rare presentation for Strongyloides hyperinfection in an immunocompetent patient

Strongyloides stercoralis is an intestinal nematode. It is widely distributed in the tropics and sub-tropics of the world. It can cause a wide array of illnesses ranging from asymptomatic autoinfection to a severe form of hyperinfection and disseminated strongyloidiasis. Here we report a case of a 73-year-old patient presenting with obstructive shock with bipedal edema without any evidence of adrenal insufficiency. An upper gastrointestinal endoscopy revealed Strongyloides larva in the lumen of duodenal crypts. Stool examination and broncho-alveolar lavage revealed the presence of S. stercoralis larva. Computed tomography of pulmonary angiography revealed pulmonary thromboembolism. A long segment thrombus was also noted in the right external iliac vein on color Doppler with negative screening for malignancy on computed tomography scan. This case suggests that pulmonary thromboembolism with anemia and hypoalbuminemia could be a rare presentation of a systemic illness like Strongyloides hyperinfection in an immunocompetent patient from the tropics.