| Popis: |
Objective: We present a patient with idiopathic thrombocytopenic purpura (ITP) who developed fatal Strongyloides stercoralis hyperinfection and E. coli meningitis three months after the onset of glucocorticoid treatment. Case Report: A 65-year- old male farmer from Zagreb County with a history of alcohol abuse was treated due to ITP with methylprednisolone for three months. For the last six weeks, he has had diarrhoea, vomiting and weight loss. The stools were negative for parasites and their eggs. He was examined by gastroscopy and colonoscopy, suggesting ulcerative colitis, but biopsy examination of duodenal mucosa revealed worm-like structures matching S. stercoralis. The patient was admitted to the hospital for diagnostic workup, but he developed fever and consciousness deterioration on the third day of hospitalization. Cerebrospinal fluid (CSF) analysis suggested bacterial meningitis. Blood and CSF cultures grew E. coli with the same phenotypic characteristics. Chest X-ray showed bilateral infiltrations, while the abdominal CT revealed pancolitis. Serology was positive for S. stercoralis, while stool samples demonstrated S. stercoralis rabditoid larvae. The parasites were not visualized in respiratory secretions or CSF. The patient was in septic shock with multiorgan failure, which was followed by ischemic cerebrovascular incident. He was treated with ceftriaxone, albendazole and ivermectin. Despite targeted and supportive treatment, the patient passed away on the eighteenth day of hospitalization. Conclusion: In non- immunocompromised population, S. stercoralis causes chronic and asymptomatic infection. In immunocompromised patients, it can cause hyper and/or disseminated infection occasionally accompanied by gram-negative sepsis. Glucocorticoids are immunosuppressants most frequently associated with S. stercoralis reactivation, due to cellular immunity depression, enabling rapid rabditoid to filariform larva transformation with high parasite numbers in intestines and lungs. Patients undergoing immunosuppressive therapy should be screened for S. stercoralis by serology and advised on hygienic measures to prevent acquisition of this primarily human parasite. |
