Letter to the Editor

Prompt Diagnosis and Treatment of Strongyloidiasis in a Renal Transplant Patient

Authors: Alexandros Briasoulis, MD, George Psevdos, MD

Abstract

To the Editor:


A 44-year-old woman on hemodialysis for the last nine years received a cadaveric renal transplant one month prior to presentation. She had immigrated to the United States from Guyana at age 29 years and subsequently had never traveled to an area where strongyloidiasis was known to be endemic. The patient was on sirolimus and prednisone, and she presented with multiple episodes of watery, non-bloody diarrhea, nausea, vomiting, and a temperature of 100.50F. The complete blood count was normal. Computed tomography (CT) of the abdomen with contrast revealed proximal small bowel wall thickening, and the ova and parasite examination of stool showed multiple motile filariform and rhabditiform larvae of S. stercoralis (SS). The patient received 200 mg/kg of ivermectin orally, given once daily for two days with a repeat dose after two weeks to ensure eradication. She improved rapidly without any complications.

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References

1. Roxby AC, Gottlieb GS, Limaye AP. Strongyloidiasis in transplant patients. Clin Infect Dis 2009;49:1411–1423.
 
2. Schad GA. Cyclosporine may eliminate the threat of overwhelming strongyloidiasis in immunosuppressed patients. J Infect Dis 1986;153:178.
 
3. Palau LA, Pankey GA. Strongyloides hyperinfection in a renal transplant recipient receiving cyclosporine: possible Strongyloides stercoralis transmission by kidney transplant. Am J Trop Med Hyg1997;57:413–415.