Strongyloides stercoralis hyperinfection and disseminated tuberculosis

Asymptomatic infection due to Strongyloides stercoralis may result in severe disease after treatment with systemic steroids. A case of S. stercoralis hyperinfection in a woman who was treated with systemic steroids for cerebral tuberculosis is reported. A 52-year-old female patient was admitted for a brain space–occupying lesion. A biopsy revealed tuberculoid-like giant cells necrotizing granulomatous reaction. Antituberculous (anti-tb) therapy and corticosteroids were started for suspected cerebral tuberculosis. Ten days after admission, the patient developed respiratory failure. A chest computed tomography showed multiple dense peripheral nodular infiltrates not seen at admission chest x-ray. Taking the patient’s epidemiological background into account, ivermectin treatment was initiated, leading to clear improvement in her clinical condition. S. stercoralis was isolated from a fecal sample. Ivermectin empirical treatment before initiation of high-dose corticosteroids in patients from endemic areas could be the best strategy for prevention of hyperinfection by this parasite.