Strongyloides Stercoralis Infection After the use of Emergency Corticosteroids

A Case Report on Hyperinfection Syndrome

George Vasquez-Rios; Roberto Pineda-Reyes; Eloy F. Ruiz; Angelica Terashima; Fernando Mejia


J Med Case Reports. 2019;13(121) 

In This Article


Strongyloides stercoralis is an intestinal nematode with a worldwide distribution.[1] Rural regions in tropical and subtropical countries are known to have a high prevalence of this organism.[1,2] Travelers, military personnel, and immigrants coming to developed countries can host this parasite for years without expressing any complaint.[1–3] Symptomatic strongyloidiasis may manifest with gastrointestinal (GI) complaints and asthma-like symptoms.[4,5] However, patients undergoing immunosuppressive therapy or with severely debilitated immune status can develop an unusual phenomenon known as hyperinfection syndrome (HS).[6,7] HS is characterized by critical illness and multi-organ dysfunction due to massive dissemination of the parasite.[6–8]

Discussions about the association between asthma and Strongyloides date back to the 1960s[9–11] and a few cases of patients with asthma suffering exacerbations attributed to S. stercoralis infection have been reported in the literature.[12–34] Although the underlying pathophysiology is still unclear, corticosteroid use during asthma exacerbations could trigger severe forms of disease, including Strongyloides HS.[2–5] Therefore, HS remains an obscure cause of respiratory distress among individuals with asthma with high mortality rates if the diagnosis is delayed.[6–8]

This is a case report of a patient who survived an unusual presentation of hyperinfection by S. stercoralis, masquerading as an asthma exacerbation. There are limited data on patients who survived aggressive forms of Strongyloides HS especially after receiving high doses of corticosteroids.[7] Therefore, there is a need for further research to optimize current management recommendations. This study aims to provide critical care physicians and internists with clinical clues that may help them arrive at the diagnosis in a timely fashion as well as guide management.