Korean J Pathol.  2002 Aug;36(4):266-270.

Fatal Strongyloidiasis with Residual Cutaneous Larvae: An Autopsy Case Report

• Kim NR
• Kim DS
• Han J
• Choe DC

Abstract

Strongyloides stercoralis hyperinfection in immunocompromised patients is difficult to control due to delayed diagnosis, especially in nonendemic areas. A 70-year-old diabetic woman came in with an intermittent diarrhea. She received massive steroid therapy for a week under the impression of idiopathic gastrointestinal eosinophilic syndrome. Diagnosis of strongyloidiasis was made by demonstration of filariform larvae in two repeated sputum specimens two months later. Despite massive administration of albendazole, she died of diabetic ketoacidosis and septic shock. Autopsy revealed a diffusely thickened bowel wall, superimposed invasive pulmonary aspergillosis and the near total destruction of the lungs. Filariform larvae were detected only in the cutaneous lesions. It was presumed that Strongyloides stercoralis hyperinfection was caused by autoinfection in the patient's immunosuppressed status. The present case has two clinical importances; first, intensive treatment with albendazole could erradicate parasites except for the skin but sepsis presumably occurred due to a hypersensitivity reaction against liberated endotoxins during the death of the parasites by the drug. Second, cutaneous parasitic lesion resists the intensive antihelminthic treatment in an immunocompromised host.

Keyword

Strongyloides stercoralis-Skin-Autopsy-Immunosuppression

MeSH Terms

Aged
Albendazole
Autopsy*
Delayed Diagnosis
Diabetic Ketoacidosis
Diagnosis
Diarrhea
Endotoxins
Eosinophils
Female
Humans
Hypersensitivity
Immunocompromised Host
Invasive Pulmonary Aspergillosis
Larva*
Lung
Parasites
Sepsis
Shock, Septic
Skin
Sputum
Strongyloides stercoralis
Strongyloidiasis*
Albendazole
Endotoxins