Association of Strongyloides Infection and Cirrhosis: A Case Report

Abstract

Introduction: Strongyloidiasis is a parasitic infection that typically results in mild symptoms and rarely causes severe or disseminated disease. Seldom encountered in the United States, it is usually only considered when a patient presents with persistent eosinophilia and/or hyperinfection with multiorgan involvement. Little is known regarding the impact that strongyloidies has on the progression of cirrhosis. We discuss a case of a Puerto Rican male with cirrhosis and strongyloides exposure. Case presentation: A 55—year—old male with decompensated cirrhosis secondary to alcohol abuse and hepatitis C virus (HCV) infection was admitted to hospital with malaise. He was diagnosed with hepatocellular carcinoma nine months prior and was on the liver transplant list, however, he was removed due to tumor progression. During liver transplant work—up, he was found to be strongyloides IgG positive. During this hospitalization he received one dose of ivermectin 18mg orally for strongyloides and follow up stool O&P was negative for parasites. His liver function remained poor and he was eventually transitioned to palliative care and discharged with hospice. Discussion: The relationship between strongyloides and cirrhosis is poorly studied. A PubMed literature search only listed a few articles relating the parasite and cirrhosis. It is documented that patients with cirrhosis are more likely to have strongyloidiasis, especially in regions where the parasite is prevalent. For instance, a prospective study in Brazil revealed that 40.2% of alcoholic cirrhotic patients had stroingyloides infection. It is also documented that antiviral treatment for liver diseases such as HCV may result in reactivation of chronic strongyloides and cause hyperinfection. Interestingly, there is no data in reference to the temporal relationship between the parasite and cirrhosis. It is believed that having a compromised immunity with HCV, human immunodeficiency virus (HIV) or cirrhosis makes a patient more susceptible to not clearing strongyloides or even developing the hyperinfection state. However, knowing that chronic strongyloides can cause liver disease itself brings us to question if the parasite can further promote cirrhosis in the first place or even the chance of developing HCC. Further studies are required to expand upon this association.