Activating Dormant Strongyloidiasis Secondary to COVID-19 Treatment

The SARS-CoV-2 pandemic has grown into a major global concern with huge efforts to combat the spread.  Exaggerated inflammatory response plays a major role in which was the rationale to use corticosteroids as a treatment option. However, multiple studies showed an association between of opportunistic and bacterial infections in patients under corticosteroid therapy. We report a case of a 76-year old patient diagnosed with COVID-19 pneumonia, treated with 10 days Dexamethasone and Remdesivir who presented with abdominal symptoms with eosinophilia. Biopsy and stool studies revealed  strongyloides stercoralis larvae. The patient was treated with 2 doses of Ivermectin with significant clinical resolution. Clinician should have high clinical suspicion for Strongloydiasis in patients who have lived or visited Strongyloides stercoralis endemic areas and for patients with unexplained eosinophilia.  Prompt treatment with Ivermectin is crucial for confirmed cases and should be also implemented empirical in high risk groups, where obtaining a diagnosis is unfeasible.