Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases

Abstract

Two cases of Strongyloides stercoralis hyperinfection are described. Both patients were expatriates from the Indian subcontinent, and reported the use of corticosteroids. The first patient presented with severe pulmonary disease that necessitated respiratory support, followed by acute abdomen and intestinal obstruction and he succumbed to these diseases. The second patient also presented with acute pulmonary disease, which responded to antihelmintic treatment and supportive care; however, he died later due to his primary disease. The clinical features of S stercoralis hyperinfection are nonspecific; therefore, a high index of suspicion is required for early diagnosis and to start appropriate therapy. Because of the seriousness of the disease and the associated high mortality we suggest screening for S stercoralis in patients from endemic areas who will be taking immunosuppressive therapy.

Figure 1

Cytologic examination of the bronchial wash showing a S stercoralis worm in a background containing some cellular debris (Papanicolaou stain ×400).

Figure 2

Low power view of the resected small bowel showing numerous larvae of S stercoralis in the mucinous material in between the villi (hematoxylin and eosin ×100).

Figure 3

High power microscopic view showing larvae embedded within the small bowel villi. Notice the dark purplish organs surrounded by translucent sheath (coat) (hematoxylin and eosin ×400).