Case Report: Strongyloides stercoralis Hyperinfection in a Patient with Chronic Lymphocytic Leukemia

Abstract

Strongyloides stercoralis is an intestinal nematode that can cause disseminated infection in an immunocompromised host. It is most commonly acquired in developing countries. It was previously a common infection in many parts of the United States, particularly in the Appalachian region, but is rarely identified currently. Here, we describe a patient born and raised in Appalachia, with no history of travel outside the United States, who presented with chronic lymphocytic leukemia and S. stercoralis hyperinfection characterized by acute respiratory failure, altered mental status, and extended-spectrum-beta-lactamase Klebsiella pneumoniae bacteremia. Despite prompt identification of the parasite on sputum microscopy and initiation of therapy with oral ivermectin and meropenem, the patient subsequently died. This case highlights the continued possibility of S. stercoralis infection in patients from Appalachia.

Figure 1.

Computed tomography of the chest with bilateral lower lobe consolidation and edema.

Figure 2.

Wet mount of material obtained from a tracheal aspirate showing larval forms consistent with the filariform stage of Strongyloides stercoralis (original magnification, ×40). This figure appears in color at www.ajtmh.org.

Figure 3.

Wright’s stain on material obtained from a tracheal aspirate highlighting larval forms consistent with Strongyloides stercoralis (original magnification, ×40). This figure appears in color at www.ajtmh.org.

Figure 4.

The Appalachian region. This figure appears in color at www.ajtmh.org.