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Strongyloidiasis Hyperinfection in a Patient with a History of Systemic Lupus Erythematosus

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  • Department of Pathology, Department of Surgery, and Department of Gastroenterology, Los Angeles County-University of Southern California Medical Center, Los Angeles, California

Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis, a nematode predominately endemic to tropical and subtropical regions, such as Southeast Asia. Autoinfection enables the organism to infect the host for extended periods. Symptoms, when present, are non-specific and may initially lead to misdiagnosis, particularly if the patient has additional co-morbid conditions. Immunosuppressive states place patients at risk for the Strongyloides hyperinfection syndrome (SHS), whereby the organism rapidly proliferates and disseminates within the host. Left untreated, SHS is commonly fatal. Unfortunately, the non-specific presentation of strongyloidiasis and the hyperinfection syndrome may lead to delays in diagnosis and treatment. We describe an unusual case of SHS in a 30-year-old man with a long-standing history of systemic lupus erythematosus who underwent a partial colectomy. The diagnosis was rendered on identification of numerous organisms during histologic examination of the colectomy specimen.

Author Notes

* Address correspondence to Evan E. Yung, Department of Pathology and Laboratory Medicine Los Angeles County-University of Southern California Medical Center, 1200 North State Street, Clinic Tower A7E, Los Angeles, CA 90033. E-mail: evan.yung@usc.edu

Authors' addresses: Evan E. Yung, Cassie M. K. L. Lee, and Parakrama T. Chandrasoma, Department of Pathology and Laboratory Medicine, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, E-mails: evan.yung@usc.edu, cassiele@usc.edu, and ptchandr@usc.edu. Joshua Boys and Daniel J. Grabo, Department of Surgery, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, E-mails: joshua.boys@med.usc.edu and daniel.grabo@usc.edu. James L. Buxbaum, Department of Gastroenterology, University of Southern California, Los Angeles, CA, E-mail: james.buxbaum@med.usc.edu.

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