Abstract
STRONGYLOIDES STERCORALIS INFECTION AFTER SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT; A CASE REPORT IN SURVIVAL Ameena Bagree, Amber Podoll, University of Texas Health Science Center, Houston, Texas USA Strongyloides stercoralis hyperinfection has been described rarely in single solid organ transplant patients but never in dual organ transplants to date. It is associated with a very high mortality rate (80-90%). We present a 50 year old Canadian-born male 4 months status post simultaneous pancreas kidney (SPK) transplant that was maintained on prograf, mycophenolic acid and low dose prednisone. He had several months of indolent symptoms of nausea and diarrhea with no identifiable source and multiple negative stool cultures. He, then, acutely represented with diarrhea, vomiting, larva currens abdominal rash, and acute respiratory failure with no readily identifiable exposures. Mycophenolic acid was discontinued. Extensive Strongyloides larval infiltration was detected by duodenal biopsy with massive shedding in nasogastric and respiratory secretions. An initial regimen of enteric Ivermectin 15mg daily and Albendazole 400mg BID was started. His Ivermectin was titrated to three times daily. The patient improved clinically and was extubated 10 days after initiation of therapy. Ivermectin was discontinued following negative larval samples from stool, tracheal, and gastric aspirates but had to be resumed due to one episode of recurrence of larva. Once the larval samples cleared, the ivermectin dosing was eventually minimized to the lowest possible dose and tapered off along with albendazole. The main concern during his therapeutic course was diminished responsiveness and neurotoxicity from ivermectin. The patient has now begun to make a slow neurologic recovery and long term outcomes remain to be determined. His renal and pancreatic grafts remained fully functional throughout his illness. This unique case highlights the importance of aggressive, early diagnosis and proposes a potential treatment regimen that can reduce this infection’s high mortality.
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