Strongyloides stercoralis infection in a patient initiating corticosteroid therapy for hypereosinophilia: A case report

Strongyloides stercoralis (S. stercoralis) is a soil-transmitted nematode that is endemic to tropical and subtropical regions. S. stercoralis has the ability to cause autoinfection, potentially leading to a chronic disease that can last for decades or result in severe hyperinfection especially in individuals who are taking corticosteroids or other immunosuppressive medications. Here, we report the case of a patient presenting a two-week history of symptoms including cough, fatigue, weight loss, pruritus, and rash. Due to a significant increase in the percentage of eosinophils, the patient was referred to the hematology clinic. The patient underwent a comprehensive evaluation that included an autoimmune panel, genetic testing, and imaging methods. The results of these investigations were found to be normal. The upper gastrointestinal system endoscopy revealed eosinophilic duodenitis and corticosteroid treatment was initiated. The commencement of corticosteroid therapy resulted in a worsening of the patient's symptoms. In the repeated endoscopy of the upper gastrointestinal tract, the presence of S. stercoralis larvae was observed between the crypts. Subsequently, stool tests for S. stercoralis diagnosis were also found to be positive. The patient was at risk of developing a hyperinfection syndrome. Corticosteroids are commonly used to reduce inflammation and manage symptoms associated with eosinophilic disorders. The immunosuppressive effects of corticosteroids are known to precipitate S. stercoralis hyperinfection syndrome, which can result in significant morbidity and mortality. This case highlights the importance of maintaining a high index of suspicion for S. stercoralis in patients undergoing immunosuppressive therapy, particularly when presenting with unexplained eosinophilia.