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Cho, Kwon, Ha, Oh, Jin, Heo, Lee, and Cho: A Case of Steroid-induced Hyperinfective Strongyloidiasis with Bacterial Meningitis
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(5): 330-334.

Published online: 22 November 2012

DOI: https://doi.org/10.4166/kjg.2012.60.5.330

A Case of Steroid-induced Hyperinfective Strongyloidiasis with Bacterial Meningitis

Joo Yun Cho, Joong Goo Kwon, Kyung Ho Ha, Jae Young Oh, Myung In Jin, Seong Wook Heo, Geun Ho Lee1, Chang Ho Cho2

Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

1Department of Family Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea.

2Department of Pathology, Catholic University of Daegu School of Medicine, Daegu, Korea.

Correspondence to: Joong Goo Kwon, Department of Internal Medicine, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 705-718, Korea. Tel: +82-53-650-4215, Fax: +82-53-628-4005, kwonjg@cu.ac.kr

Received 23 September 2011       Revised 29 October 2011       Accepted 29 October 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Strongyloides stercoralis, Meningitis, Steroids

Figures and Tables

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).
kjg-60-330-g003
Fig. 4
Brain MRI finding. It showed a subtle enhancing lesion in the left superior frontal gyrus, suspicious of subacute infarction.
kjg-60-330-g004

Notes

Financial support: None.

Conflict of interest: None.

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