Fatal strongyloidosis following corticosteroid therapy in a patient with chronic idiopathic thrombocytopenia

A patient with chronic idiopathic thrombocytopenia and fatal strongyloides hyperinfection syndrome following prolonged corticosteroid therapy is brief ly described. Diagnosis was difficult to perform due to absence of eosinoph ilia and diarrhea at presentation, as well as to the negativity of multiple stool specimens examined by direct microscopy of saline smear, formol-ethe r concentration techniques, and Baermann's test. The striking hypoalbuminem ia in the setting of the normal results of liver function tests and prothro mbin time was assumed to be due to enteropathy. Therefore, an upper endosco py was undertaken, revealing Strongyloides stercoralis (SS) larvae in the b iopsy specimens of the gastric and duodenal mucosa. The SS larvae were also demonstrated in the multiple specimens of the concentrated sputum. Despite thiabendazol treatment, death ensued. On autopsy, SS larvae were recovered in the gastrointestinal tract and lungs. The importance of early diagnosis and of ruling out strongyloidosis prior to administration of corticosteroi ds are discussed, as well as the pathogenetic aspects of strongyloidosis in the patient under corticosteroids.