An unusual presentation of strongyloidiasis in a patient on chronic dialysis causing clinical deterioration

Abstract Background Strongyloidiasis is a parasitic infection caused by the helminth Strongyloides stercoralis. Strongyloidiasis is endemic in tropical regions, including Mali. Diffuse forms of the disease occur in seriously immunocompromised patients and those undergoing immunosuppressant therapies, such as corticosteroids. We report an unusual case of disseminated strongyloidiasis in a patient undergoing chronic hemodialysis in Mali. Case presentation A 62-year-old woman from Mali with a past medical history of diabetic nephropathy was followed in our clinic. She has been undergoing chronic hemodialysis for two years due to diabetic nephropathy. She denied taking corticosteroids or immunosuppressant medications. Over three months, she presented with symptoms of non-specific abdominal pain, with alternating of diarrhea and constipation, and a dry cough with fever. At admission, physical examination found an altered general condition, blood pressure of 140/90 mmHg, heart rate of 97 beats per minute, and temperature of 38.7 °C. Ancillary tests, including urine culture, identified Strongyloides stercoralis. This was confirmed by parasitological examination of stool samples taken on three successive occasions. The patient was treated with oral 200 µg/kg ivermectin combined with 400 mg albendazole. His clinical presentation got improved significantly. One month later, the repeated parasitological and urinary tests were negative. Conclusion Severe strongyloidiasis is commonly seen in immunocompromised patients and usually have poor prognosis. This case highlights the need for thorough investigation of such infections in chronic immunodeficient individuals, often associated with end-stage renal failure. Therefore, we suggest parasitological monitoring or its prophylactic treatment at regular intervals for patients at high risk of developing disseminated and severe strongyloidiasis.