Strongyloides Hyperinfection Syndrome Following Immunosuppressant Therapy for <scp>COVID</scp>‐19: A Case Report With Literature Review

Strongyloides hyperinfection and disseminated infections are usually associated with immunosuppression; these severe manifestations occur in a minority of cases. The use of immunosuppressants such as corticosteroids and Baricitinib for treating COVID-19 pneumonia can be responsible for patients' immunosuppression and cause Strongyloides hyperinfection syndrome. The chance increases when the patient belongs to countries or regions where chronic infection with Strongyloides is more prevalent. This case report describes the clinical scenario of a 78-year-old man from southeastern Bangladesh who was initially diagnosed with COVID-19 pneumonia. His condition improved after receiving corticosteroid therapy for approximately 1 month at various doses and Baricitinib therapy for more than a week due to moderate-to-severe COVID-19 pneumonia. Approximately 2 months later, he presented with low-grade fever, diarrhea, and itching throughout the body. Blood analysis revealed eosinophilia; stool examination revealed Rhabditiform larvae of Strongyloides stercoralis. The patient was diagnosed with Strongyloides hyperinfection syndrome and treated with Albendazole and Ivermectin. His clinical condition gradually improved, and he was discharged from the hospital. The stool sample was sent for a repeat microscopic examination after 14 days, which yielded a negative result. Clinicians should be more vigilant while prescribing corticosteroids and other immunosuppressants for a prolonged period. Proper screening to identify asymptomatic cases of strongyloidiasis, followed by empirical treatment of screening-positive cases, prompt detection, and management of severe manifestations, is crucial to reduce further morbidity and mortality related to Strongyloides stercoralis.