Strongyloidiasis presenting as eosinophilic ascites.

Approximately 30 million people are thought to harbour Strongyloides stercoralis, a parasitic nematode that is endemic in Latin America, sub-Saharan Africa, South–east Asia, and south–eastern U.S.A. (Liu and Weller, 1993; Siddiqui and Berk, 2001). Although auto-infection may lead to chronic or intermittent symptoms that last several decades, even in individuals who have not recently travelled to endemic areas, human infection with this nematode is typically asymptomatic or only causes mild gastro-intestinal symptoms (Liu and Weller, 1993). In immunocompromised individuals, however, strongyloidiasis is often devastating and the cause of high mortality, with pneumonia, meningitis and Gram-negative sepsis among the life-threatening conditions that can occur as the St. stercoralis larvae migrate throughout the body. An unusual case of strongyloidiasis in a young, otherwise healthy patient, who presented (in New York, NY) with dysphagia, episodes of diarrhoea alternating with constipation, and increasing abdominal girth (all of which resolved following treatment) is described and discussed below.