Severe strongyloidiasis and systemic vasculitis: comorbidity, association or both? Case-based review

Rheumatol Int. 2018 Dec;38(12):2315-2321. doi: 10.1007/s00296-018-4178-y. Epub 2018 Oct 23.

Abstract

A possible association between strongyloidiasis and systemic vasculitis is rarely reported in the literature. We report the case of a patient with severe strongyloidiasis and an angiographic finding consistent with polyarteritis nodosa. Diagnosis of strongyloidiasis was made by finding of larvae and adult parasites in samples of the upper gastrointestinal tract mucosa and stool. The patient was treated with albendazole, ivermectin and corticosteroid withdrawal. This therapy led to the resolution of symptoms, with repeated stool samples negative for S. stercoralis. However, the clinical course was complicated with pulmonary tuberculosis. Despite tuberculostatic therapy and supportive measures, a lethal outcome occurred. The report is followed by a focused review of the available literature on the association of strongyloidiasis and systemic vasculitis.

Keywords: Corticosteroids; Polyarteritis nodosa; Strongyloides stercoralis; Strongyloidiasis; Systemic vasculitis; Tuberculosis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Aged
  • Albendazole / therapeutic use
  • Animals
  • Antinematodal Agents / therapeutic use
  • Fatal Outcome
  • Feces / parasitology*
  • Gastric Mucosa / parasitology*
  • Humans
  • Intestinal Mucosa / parasitology*
  • Ivermectin / therapeutic use
  • Male
  • Methylprednisolone / administration & dosage
  • Polyarteritis Nodosa / complications*
  • Polyarteritis Nodosa / diagnostic imaging
  • Polyarteritis Nodosa / drug therapy
  • Severity of Illness Index
  • Strongyloides stercoralis / drug effects
  • Strongyloides stercoralis / isolation & purification*
  • Strongyloidiasis / complications*
  • Strongyloidiasis / diagnosis
  • Strongyloidiasis / drug therapy
  • Strongyloidiasis / parasitology
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Antinematodal Agents
  • Ivermectin
  • Albendazole
  • Methylprednisolone