Concurrent Hansen’s Disease and Strongyloidiasis: A Diagnostic and Therapeutic Challenge

Abstract Strongyloidiasis, caused by Strongyloides stercoralis, is a soil-transmitted helminthiasis with the unique capacity for autoinfection, enabling chronic persistence within the host. While often asymptomatic, it may progress to hyperinfection or disseminated disease in immunocompromised individuals, particularly those on corticosteroids. Leprosy patients are especially vulnerable due to prolonged corticosteroid use for lepra reactions. We report a 42-year-old man with Hansen’s disease on long-term prednisolone for recurrent erythema nodosum leprosum, who presented with bilious vomiting, abdominal discomfort, and significant weight loss. Investigations revealed anemia, electrolyte disturbances, and imaging suggesting small bowel obstruction. Active motile larvae suggestive of Strongyloides stercoralis were observed in routine microscopic examination of stool. He was treated with ivermectin and albendazole, alongside steroid tapering and hydrocortisone replacement for adrenal insufficiency, resulting in rapid clinical recovery and parasitological clearance. This case emphasizes the need for early suspicion, routine examination before immunosuppressive therapy, and prompt treatment to avert fatal outcomes.