Strongyloides hyperinfection syndrome in an immunocompetent host resulting in bandemia and death

Abstract

Strongyloides stercoralis infection is usually asymptomatic but can result in a hyperinfection syndrome, most commonly triggered by acquired or iatrogenic immunosuppression. Here, we present a case of a man aged 60 years originally from a strongyloides endemic area with a medical history of alcohol abuse who presents with strongyloides hyperinfection syndrome (SHS) complicated by partial small bowel obstruction, pulmonary haemorrhage, large bandemia without eosinophilia and cardiac arrest resulting in death. This case is notable for the presence of bandemia and absence of eosinophilia, lack of historical risk factors for hyperinfection, specifically corticosteroid immunosuppressants, and dramatic decline in clinical status which ultimately resulted in the patient's death. Clinicians should suspect SHS in immunocompetent patients who are from an endemic area and who have persistent gastrointestinal and/or pulmonary manifestations in the absence of a clear cause.

Figure 1

A strongyloides larvae (centre of the photograph) is seen crossing an alveolar septae. There is minimal surrounding inflammation (H&E ×400 magnification).

Figure 2

Bone marrow biopsy shows typical marrow elements with numerous eosinophils. (H&E ×400.)