Strongyloidiasis – case report and literature review

Introduction. Strongyloidiasis is a disease caused by the parasite Strongyloides stercoralis. It is a well known parasite of many populations, especially of tropical and subtropical areas. The primary role in maintaining and spreading strongyloidiasis is played by the low level of sanitary and hygienic conditions. Nowadays the disease seems to have an increased role also in our latitude. There is an increased possibility of infection in endemic areas due to increasing numbers of journeys of Polish people to tropical countries. Strongyloides stercoralis infection after the patient returns home is frequently asymptomatic or has a mild course, which makes the clinical diagnosis very difficult. There are also diagnostic difficulties because of the significant difference between sensitivity of serological diagnostic tests in immigrants from endemic areas with chronic infection and travellers with infection after brief exposure.
Objective. To present a case of strongyloidiasis in which there occurred late, difficult-to-diagnose dermatological and gastrointestinal symptoms and resistance to treatment with albendazole.
Case report. A 41-year-old nurse was referred to a dermatologist with erythematous-oedematous plaques on the buttocks. In spite of negative mycological examinations the patient was treated with oral terbinafine without improvement. Detailed analysis of the case history suggested infection with Strongyloides stercoralis (she worked for many years in India and returning home noticed, 3 years before appearance of skin eruption, abdominal pain and some jejunal abnormalities). Serological tests and parasitological examination of faeces were negative, whereas ELISA test for strongyloidiasis gave a positive result. The patient was treated twice with albendazole without improvement. Remission of skin lesions and gastrointestinal symptoms was obtained after therapy with ivermectin.
Conclusions. The presented case indicates that strongyloidiasis should be taken into consideration in patients returning from the tropics with atypical skin changes. The diagnosis and treatment of Strongyloides stercoralis infection may be difficult and such cases should be referred to specialized centres.