Fatal septicemic shock associated with Strongyloides stercoralis infection in a patient with angioimmunoblastic T-cell lymphoma: a case report and literature review

Parasitology International
M Z AbdelrahmanW Z Nazlee

Abstract

Strongyloides stercoralis infection can persist in the host for several decades, and patients with cancer and other clinical conditions who are exposed to immunosuppressive therapy are at risk of developing hyperinfection. This is a case of angioimmunoblastic T-cell lymphoma (AITL) in a patient with lymphadenopathy and bulky neck mass. Severe sepsis and episodes of diarrhea were observed upon the first cycle of cyclophosphamide, doxorubicin, oncovin (vincristine) and prednisone (CHOP) regime chemotherapy preceded by high dose of dexamethasone. There was Klebsiella pneumoniae bacteremia and moderate eosinophilia. Rhabditiform S. stercoralis larvae were observed in the stool, and this was confirmed by real-time PCR. Strongyloides-specific IgG and IgG4 were also positive. The patient was treated with oral albendazole (400mg/day) for 3 days and intravenous tazocin (4.5gm/6 hours) for 5 days; however he succumbed following multi-organ failure. This is likely a case of Strongyloides hyperinfection with secondary bacteremia.

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Citations

Mar 19, 2013·Acta Tropica·Shailendra Kapoor
Aug 10, 2013·Pathogens and Disease·Marc P HübnerAchim Hoerauf
Oct 7, 2016·Respiratory Medicine Case Reports·Kevin GipsonLuke A Wall
Nov 5, 2016·Immunology Letters·Marcelo Arantes LevenhagenJulia Maria Costa-Cruz
Feb 18, 2017·Journal of Parasitology Research·Tiago MendesSilmara Marques Allegretti
Nov 24, 2016·Journal of Parasitic Diseases : Official Organ of the Indian Society for Parasitology·Dina Abdallah ZaghloolWael Ahmed Shahin
Jan 1, 2013·Journal of Intensive Care·Yoshiaki IwashitaHiroshi Imai

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