Subconjunctival corticosteroid therapy complicated by hyperinfective strongyloidiasis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Gastroenterology

Background:

• Corticosteroids are commonly used in ophthalmology for treating inflammatory conditions.
• Strongyloides stercoralis is an intestinal nematode that can cause chronic asymptomatic infections.

Observation:

• A patient receiving subconjunctival dexamethasone for a corneal ulcer developed severe gastrointestinal strongyloidiasis.
• The patient presented with peptic ulcer hemorrhage, gastric outlet obstruction, and disseminated infection.
• Complications included meningitis and Serratia marcescens bacteremia.

Findings:

• Subconjunctival corticosteroid administration led to systemic immunosuppression.
• This immunosuppression transformed an asymptomatic Strongyloides infection into hyperinvasive strongyloidiasis.
• The patient's eosinophil count was noted prior to therapy.

Implications:

• Physicians should consider screening for Strongyloides in patients with risk factors before initiating corticosteroid therapy.
• This case underscores the potential systemic effects of localized corticosteroid injections.
• Early recognition and treatment of disseminated strongyloidiasis are crucial for patient survival.