Iranian Journal of Parasitology 2016. 11(3):411-416.

Disseminated Strongyloidiasis in an Immunodeficient Patient (Pemphigus Vulgaris) Due to Corticosteroid Therapy: A Case Report


Strongyloidiasis is a frequent misdiagnosed parasitic infection in the world that caused by Strongyloides stercoralis. In Iran, the disease is predominantly reported from warm and humid climate provinces. The patient was a 54-yr-old man, originated from Khuzestan Province with a history of pemphigus and diabetes that was treated with high-dose of corticosteroid drugs before admission in a non-private hospital in Shiraz, Iran in 2014. After different primary diagnosis and administrating of several drugs, endoscopy and histopatholgical biopsy revealed a massive S. stercoralis infection in the duodenal mucosa and gastric wall. In spite treating with anti-helminthic drugs in the last days, due to using different steroid drugs, clinical manifestations of the patient were exacerbated and he was expired on the seventeenth day due to severe dyspnea. Physicians’ awareness and using various diagnosis methods like serology, endoscopy, and biopsy should be considered in the endemic areas. In suspicious cases, anthelmintic drugs should be started before the initiation of immunosuppressive therapy.


Pemphigus; Strongyloides stercoralis; Strongyloidiasis; Diabetes; Iran

Full Text:



Montes M, Sawhney C, Barros N. Strongyloides stercoralis: there but not seen. Curr Opin Infect Dis. 2010; 23(5):500-4.

Marcos LA, Terashima A, Dupont HL, Gotuzzo E. Strongyloides hyperinfection syndrome: an emerging global infectious disease. Trans R Soc Trop Med Hyg. 2008; 102(4):314-8.

Keiser PB, Nutman TB. Strongyloides stercoralis in the Immunocompromised Population. Clin Microbiol Rev. 2004; 17(1):208-17.

Sharifdini M, Kia EB, Ashrafi K, Hosseini M, Mirhendi H, Mohebali M, Kamranrashani B. An Analysis of Clinical Characteristics of Strongyloides stercoralis in 70 indigenous patients in Iran. Iran J Parasitol. 2014; 9(2):155-62.

Ashrafi K, Tahbaz A, Rahmati B. Strongyloides stercoralis: The Most Prevalent Parasitic Cause of Eosinophilia in Gilan Province, Northern Iran. Iran J Parasitol. 2010; 5(3):40-7.

Rokni MB. The present status of human helminthic diseases in Iran. Ann Trop Med Parasitol. 2008; 102(4):283-95.

Mowlavi G, MirAhmadi H, Rezaeian M, Kia E, Rokni M, Golestan B, Shafiei R, Fereshtehnejad S, Keramati M. Prevalence of intestinal parasites in tribal parts of Khuzestan Province during 2005-07. Govaresh. 2008; 12(4):219-28.

Shokri A, Sarasiabi KS, Teshnizi SH, Mahmoodi H. Prevalence of Strongyloides stercoralis and other intestinal parasitic infections among mentally retarded residents in central institution of southern Iran. Asian Pac J Trop Biomed. 2012; 2(2):88-91.

Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR. Albendazole is effective treatment for chronic strongyloidiasis. Q J Med. 1993; 86(3):191-5.

Dhaliwal BBS, Juyal PD: Nematode Zoonoses. In: Parasitic Zoonoses. edn.: Springer; 2013: 83-122.

Fakhar M, Gholami Z, Banimostafavi ES, Madjidi H. Respiratory hyperinfection caused by Strongyloides stercoralis in a patient with pemphigus vulgaris and minireview on diagnosis and treatment of strongyloidiasis. Comp Clin Path. 2010; 19(6):621-5.

Krishnamurthy R, Dincer HE, Whittemore D. Strongyloides stercoralis hyperinfection in a patient with rheumatoid arthritis after anti-TNF-alpha therapy. J Clin Rheumatol. 2007; 13(3):150-2.

Mora CS, Segami MI, Hidalgo JA. Strongyloides stercoralis hyperinfection in systemic lupus erythematosus and the antiphospholipid syndrome. Semin Arthritis Rheum. 2006; 36(3):135-43.

Rassiga AL, Lowry JL, Forman WB. Diffuse pulmonary infection due to Strongyloides stercoralis. JAMA. 1974; 230(3):426-7.

Scowden EB, Schaffner W, Stone WJ. Overwhelming strongyloidiasis: an unapprecia-ted opportunistic infection. Medicine. 1978; 57(6):527-44.

Malakoutian T, Mohammadi R, Asgari M, Amouzegar A. Disseminated strongyloidiasis in a patient with membranoproliferative glomeruloneph-ritis case report. Iran J Parasitol. 2015; 10(1):141-5.

Moghadam KG, Khashayar P, Hashemi M. Gastrointestinal strongyloidiasis in imm-unocompromised patients: a case report. Acta Med Indones. 2011; 43(3):191-4.

Tabei SZ, Asadian F, Fakhar M, Safaei A. Gastrointestinal hyper infection due to Strongyloides stercoralis in a patient with Behcetʼs syndrome. Comp Clin Path. 2009; 18(1):89-91.

Kia EB, Rahimi HR, Mirhendi H, Nilforoushan MR, Talebi A, Zahabiun F, Kazemzadeh H, Meamar AR. A case of fatal strongyloidiasis in a patient with chronic lymphocytic leukemia and molecular characterization of the isolate. Korean J Parasitol. 2008; 46(4):261-3.

Saraei M, Hosseinbigi B, Shahnazi M, Bijani B. Fatal Strongyloides hyper-infection in a patient with myasthenia gravis. Infection. 2014; 42(6):1039-42.

Woodring JH, Halfhill H 2nd, Berger R, Reed JC, Moser N. Clinical and imaging features of pulmonary strongyloidiasis. South Med J. 1996; 89(1):10-9.

Rivera E, Maldonado N, Velez-Garcia E, Grillo AJ, Malaret G. Hyperinfection syndrome with Strongyloides stercoralis. Ann Intern Med. 1970; 72(2):199-204.

Celedon JC, Mathur-Wagh U, Fox J, Garcia R, Wiest PM. Systemic strongyloidiasis in patients infected with the human immunodeficiency virus: a report of 3 cases and review of the literature. Medicine. 1994; 73(5):256-63.

Sadjadi SA, Damodaran C, Sharif M. Strongyloides stercoralis infection in transplanted patients. Am J Case Rep. 2013; 14:205-9.

Thompson BF, Fry LC, Wells CD, Olmos M, Lee DH, Lazenby AJ, Monkemuller KE. The spectrum of GI strongyloidiasis: an endoscopic-pathologic study. Gastrointest Endosc. 2004; 59(7):906-10.

Norsyahida A, Riazi M, Sadjjadi SM, Muhammad Hafiznur Y, Low HC, Zeehaida M, Noordin R. Laboratory detection of strongyloidiasis: IgG-, IgG4 - and IgE-ELISAs and cross-reactivity with lymphatic filariasis. Parasite Immunol. 2013; 35(5-6):174-9.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.