Case Report: Neglected case of duodenal strongyloidiasis in an immunocompromised patient

Abstract

Strongyloides stercoralis, one of the common opportunistic parasitic infections, affects a large population in many parts of tropical and subtropical regions and is often a neglected tropical disease. The parasite completes its life cycle inside the human host with a unique feature of autoinfection, persisting in the host indefinitely in dormant form and having the notorious ability to cause fetal complications in an immunocompromised individual. Many factors like corticosteroid therapy, immunosuppressive therapy for autoimmune diseases, human T lymphotropic virus, malignancy, malnutrition etc. can transform asymptomatic strongyloidiasis to fatal outcomes, from hyperinfection syndrome to parasite dissemination leading to increased risk of high mortality rates. It has been neglected in screening unless and until some clinical suspicion appeared during the course of treatment. Early diagnosis and treatment can mitigate the rapid disease activation and evolution in an immunocompromised patient. A mandatory but reliable parasite screening method should always be carried out before administering immunosuppressants, even though simple stool tests and serology are only used when suspicion arises. Our case involved a 50-year-old female on cyclophosphane for systemic lupus erythematous (SLE) who experienced repeated bouts of vomiting and loose stools. Even several days after admission, there was no satisfactory outcome with medical management; a duodenal biopsy was carried out, which revealed numerous larvae of Strongyloides stercoralis.