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Disseminated strongyloidiasis after prolonged treatment with corticosteroids

Strongyloides stercoralis is a helminth found in the soil and transmitted to humans through larval penetration of the skin. It is endemic across most of the tropical regions of the world. Infection with S. stercoralis commonly causes minimal or mild symptoms. This case report describes an interesting final diagnosis for a woman presenting with persistent nausea, vomiting and epigastric pain. Her evaluation included imaging and oesophagogastroduodenoscopy with biopsy. Her biopsy results revealed oesophageal candidiasis and disseminated strongyloidiasis. Important historical clues in this case included previous prolonged treatment with steroids, recent diagnosis of gram-negative bacteraemia, prior residence in Rwanda, and unknown predeparture treatment for S. stercoralis. She was ultimately treated with fluconazole and ivermectin with marked improvement in her symptoms.