A Case of Disseminated Strongyloidiasis in a Nepalese Patient with Leprosy

Abstract

Strongyloidiasis, a parasitic infection caused by Strongyloides stercoralis, is widely prevalent in Asian and African tropical regions. Immunosuppressed patients are at a higher risk of developing Strongyloides hyperinfection/disseminated disease. A 30-year-old Nepalese man with a history of long-term prednisolone treatment for Type 2 Leprosy reaction developed diarrhea and anorexia. Blood culture yielded growth of Pseudomonas aeruginosa, and the patient was hospitalized for antibiotic treatment. However, the patient's gastrointestinal symptoms persisted even after discharge, necessitating readmission. S. stercoralis was detected in stool and duodenal biopsy specimens. Treatment with ivermectin was initiated at the dose of 12 mg/day (0.2 μg/kg/day); however, the patient's general condition deteriorated and he died of multi-organ failure despite intensive care. During hospitalization, the serum ivermectin levels were measured twice and the measured levels of 8.97 and 11.4 ng/mL suggested adequate absorption of ivermectin from the intestinal tract. Corticosteroids increase the blood levels of ecdysteroid-like substances, which stimulate the transformation of rhabditiform larvae into infective filariform larvae that potentially promotes hyperinfection and disseminated disease. In the age of globalization, we recommend S. stercoralis screening and prophylactic oral medication for patients predisposed to latent infection with the parasite who are receiving long-term immunosuppressive therapy.