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

• Published in: Parasitology international 2012-09, Vol.61 (3), p.508-511
• Main Authors: Abdelrahman, M.Z, Zeehaida, M, Rahmah, N, Norsyahida, A, Madihah, B, Azlan, H, Nazlee, W.Z
• Format: Article
• Language: English
• Subjects: Aged; albendazole; Animals; bacteremia; case studies; chemotherapy; cyclophosphamide; Cyclophosphamide - therapeutic use; dexamethasone; diarrhea; Diarrhea - complications; Diarrhea - parasitology; Diarrhea - physiopathology; doxorubicin; Doxorubicin - therapeutic use; eosinophilia; Fatal Outcome; Gastroenterology and Hepatology; Humans; Immunoblastic Lymphadenopathy - complications; Immunoblastic Lymphadenopathy - drug therapy; Immunoblastic Lymphadenopathy - parasitology; Immunoblastic Lymphadenopathy - pathology; immunoglobulin G; Immunosuppressed patient; immunosuppression (therapy); Infectious Disease; Injections, Intravenous; intravenous injection; Klebsiella pneumoniae; larvae; lymphoma; Malaysia - epidemiology; Male; neck; parasitology; patients; prednisone; Prednisone - therapeutic use; quantitative polymerase chain reaction; risk; Septicemic shock; Shock, Septic - complications; Shock, Septic - drug therapy; Shock, Septic - parasitology; Shock, Septic - pathology; Strongyloides stercoralis; Strongyloides stercoralis - growth & development; Strongyloides stercoralis - pathogenicity; Strongyloidiasis - complications; Strongyloidiasis - drug therapy; Strongyloidiasis - pathology; T-cell lymphoma; T-lymphocytes; Treatment Outcome; vincristine; Vincristine - therapeutic use
• ISSN: 1383-5769; 1873-0329
• DOI: 10.1016/j.parint.2012.04.005

Abstract Introduction 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. Case report 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 (400 mg/day) for 3 days and intravenous tazocin (4.5gm/6 hours) for 5 days; however he succumbed following multi-organ failure. Conclusion This is likely a case of Strongyloides hyperinfection with secondary bacteremia.