A 69-year-old Korean man was admitted to emergency room with complaints of abdominal pain, vomiting, and diarrhea. Laboratory tests revealed eosinophilia, anemia, hypoproteinemia, and hyponatremia. The gastric mucosa showed whitish mottled and slightly elevated lesions on the body angle of antrum. Microscopically, chronic gastritis with incomplete intestinal metaplasia was observed. Many adult worms, larvae, and eggs in cross sections were located in the crypts. Furthermore, the filariform larvae of Strongyloides stercoralis with a notched tail were detected through the culture.
Aged ; Albendazole/therapeutic use ; Animals ; Anthelmintics/therapeutic use ; Feces/parasitology ; Female ; Humans ; Intestines/parasitology ; Korea ; Male ; Strongyloides stercoralis/*isolation & purification ; Strongyloidiasis/*diagnosis/drug therapy/parasitology

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.
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