Korean J Gastroenterol.  2012 Nov;60(5):330-334. 10.4166/kjg.2012.60.5.330.

A Case of Steroid-induced Hyperinfective Strongyloidiasis with Bacterial Meningitis

• Cho JY
• Kwon JG
• Ha KH
• Oh JY
• Jin MI
• Heo SW
• Lee GH
• Cho CH

• KMID: 1775800
• DOI: http://doi.org/10.4166/kjg.2012.60.5.330

Abstract

Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.

Keyword

Strongyloides stercoralis; Meningitis; Steroids

MeSH Terms

Adrenal Insufficiency/drug therapy
Aged
Animals
Bronchoalveolar Lavage Fluid/parasitology
Endoscopy, Gastrointestinal
Enterococcus faecium/isolation & purification
Female
Humans
Immunocompromised Host
Intestinal Mucosa/pathology
Larva/physiology
Magnetic Resonance Imaging
Meningitis, Bacterial/complications/*diagnosis/microbiology
Steroids/adverse effects/therapeutic use
Strongyloides stercoralis/growth & development/isolation & purification
Strongyloidiasis/complications/*diagnosis/parasitology
Steroids

Figure

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  Fig. 1 Endoscopic and pathologic finding of the colon. (A) Diffuse non-specific mucosal erythema was observed in the entire colon. (B) Colonic mucosa showed eosinophilic infiltrations in the lamina propria (H&E, ×400).

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  Fig. 2 Endoscopic and pathologic findings of the stomach and duodenum. Diffuse erythematous and edematous mucosa was observed in the antrum (A) and duodenum (B). (C) Gastric and duodenal mucosa showed eosinophilic infiltrates and filariform larvae of Strongyloides stercoralis (arrows; H&E, ×100).

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  Fig. 3 Bronchoscopic finding and bronchoalveolar lavage cytology. (A) No abnormal lesion was observed in the bronchus. (B) Filariform larvae of Strongyloides stercoralis was observed in bronchoalveolar lavage fluid (H&E, ×100).

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  Fig. 4 Brain MRI finding. It showed a subtle enhancing lesion in the left superior frontal gyrus, suspicious of subacute infarction.

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