Case Report: From chronic infection to disseminated strongyloidiasis: a case of corticosteroid-induced hyperinfection syndrome

Abstract

Background Strongyloides stercoralis (S. stercoralis) is a soil-transmitted nematode predominantly endemic to tropical and subtropical regions, capable of causing life-threatening hyperinfection syndrome and disseminated infection in immunocompromised individuals. With the improvement of sanitation conditions, strongyloidiasis has become increasingly uncommon. Early-stage infection presents with mild, nonspecific symptoms, posing diagnostic challenges. Case description We report a case of S. stercoralis infection in a 73-year-old female patient, evolving from initial erythematous rash to disseminated disease. The patient, with a 30-year history of bronchial asthma, developed severe hyperinfection syndrome following corticosteroid therapy. She initially presented with cutaneous petechiae and pruritus, and was diagnosed with allergic purpura. With exacerbation of respiratory symptoms, she was diagnosed with asthma complicated by fungal infection. After treatment with methylprednisolone and itraconazole, severe gastrointestinal symptoms developed. The diagnosis was confirmed only after simultaneous detection of S. stercoralis in multiple body fluid specimens. Ultimately, following discontinuation of methylprednisolone and itraconazole, and administration of albendazole, the patient gradually recovered to normal. Conclusion This case highlights the diagnostic challenges in the early stages of S. stercoralis infection and demonstrates the characteristic dissociation between leukocytosis and eosinopenia during corticosteroid-induced hyperinfection syndrome. Prompt recognition and immediate discontinuation of immunosuppressive therapy combined with anthelmintic treatment are critical for favorable outcomes in disseminated strongyloidiasis.