Strongyloides stercoralis hyperinfection syndrome: case report of therapeutic failure with ivermectin

Strongyloidiasis (or anguillulosis) is helminthosis caused by Strongyloides stercoralis found mostly in (sub)tropical areas and sometimes in temperate settings. We report a case of strongyloidiasis hyperinfection, diagnosed on a BALF in a 46-year-old woman of senegalese origin with no recent travel history. The patient initially presented to the emergency department with worsening chronic lower back pain, asthenia and a 10-day history of general deterioration. Plasma cell leukemia was diagnosed and treated with a block of dexamethasone combined with chemotherapy. Our laboratory incidentally detected the presence of Strongyloides larvae in a BAL specimen. The patient received a prophylactic dose of Ivermectin prior to the administration of high doses of corticosteroids. Once the diagnosis of hyperinfestation syndrome had been established, curative doses of Ivermectin were administered, initially by nasogastric tube and then subcutaneously. The evolution was rapidly unfavorable, with the appearance of edema and cerebral hemorrhages which led to the patient's death 10 days later.