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Case Reports
. 2023 Jul 31;38(4):e534.
doi: 10.5001/omj.2023.31. eCollection 2023 Jul.

Steroid-induced Strongyloidiasis with Cholestasis Post-COVID-19 Pneumonia

Noora Al Busaidi  1 , Fatma Al Farsi  1 , Huda Al Batashi  2 , Masoud Salim Kashoub  2 , Ahmed Al Sinani  3 , Zakariya Al Balushi  4 , Faryal Khamis  4
Affiliations
Case Reports

Steroid-induced Strongyloidiasis with Cholestasis Post-COVID-19 Pneumonia

Noora Al Busaidi et al. Oman Med J. .

Abstract

The use of immunosuppressive agents has recently been raised during the COVID-19 pandemic to manage the COVID-19-induced systemic inflammatory response and improve mortality. This widespread use of steroids and other immunomodulators for severe COVID-19 diseases might pose a potential risk of reactivation of latent diseases and the emergence of opportunistic infections such as strongyloidiasis. We report a case of strongyloidiasis with cholestasis in a middle-aged man; who was otherwise healthy and had no history of recent travel, developed three weeks after a prolonged course of steroids for the management of severe COVID-19 pneumonia. The patient was managed with a combination of albendazole and ivermectin. A high index of suspicion of strongyloidiasis in symptomatic patients post immunosuppressant therapy for severe COVID-19 is required to prevent unfavorable outcomes. In selected high-risk patients, post prolonged steroid therapy for COVID-19 pneumonia screening for strongyloidiasis and ivermectin empirical treatment might be considered even in non-endemic areas.

Keywords: COVID-19; Ivermectin; Steroids; Strongyloides.

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Figures

Figure 1
Figure 1
Rhabditiform larva of Strongyloides stercoralis in iodine stain stool sample. It has a short buccal canal (blue arrow), a bulbar portion of the rhabditoid esophagus with three portions (red arrow), and a prominent genital primordium 
(green arrow).
Figure 2
Figure 2
Abdomen ultrasound showed mildly dilated common bile duct.
See this image and copyright information in PMC

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