Hemodialysis and eosinophilia: presumptive etiology being able to mask strongyloidiasis

The authors report a case of recurrent strongyloidiasis in a former French soldier of the Indochina colonial war (1946-54). Strongyloidiasis was assoc iated with inaugural renal failure (acute steroid-resistant interstitial-ty pe), requiring permanent hemodialysis. Despite antiparasitic treatment, rel apse with digestive and pulmonary symptoms occured 10 years later, followin g chronic eosinophilia. This observation emphasises that in dialysed subjec ts, eosinophilia should always stimulate a search for parasitic etiologies before incriminating dialysis-material allergy. Strongyloidiasis is a self perpetuating helminthiasis whose distribution area is far greater than the intertropical zone. It can be completely asymptomatic, appear as late diges tive complications and be responsible for bacteraemic peaks with septic vis ceral localizations. It causes a chronic oscillating eosinophilia. Diagnosi s is usually performed by iterative stool examinations by Baermann techniqu e in order to detect Strongyloides stercoralis rhabditoid larvae. In dialys ed patients with unexplained eosinophilia awaiting renal transplant, the op tions of systematic thiabendazole (50 mg/kg) or ivermectine (0.2 mg/kg) sin gle-dose to overcame the risk of disseminated strongyloidiasis induced by i mmunosupressive post-transplantation therapy could be debated.