Rothe Kathrin, Katchanov Juri, Schneider Jochen, Spinner Christoph D, Phillip Veit, Busch Dirk H, Tappe Dennis, Braren Rickmer, Schmid Roland M, Slotta-Huspenina Julia
Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany.
Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
Parasitol Int. 2020 Jun;76:102087. doi: 10.1016/j.parint.2020.102087. Epub 2020 Feb 20.
We report a case of a fatal Strongyloides stercoralis hyperinfection syndrome (SHS) in a migrant from Kenya, who had been living in Germany for three decades. A short-course oral steroid treatment for Chronic Obstructive Pulmonary Disease (COPD) exacerbation had been administered four weeks prior to the presentation. The initial clinical and radiological findings suggested a mechanical small bowel obstruction as a cause of ileus. Our case highlights the importance of maintaining a high index of suspicion for strongyloidiasis in patients from endemic areas even years after they left the country of origin. It demonstrates that even a five-day course of prednisolone is able to trigger SHS in patients with underlying strongyloidiasis. History of frequent previous administration of oral prednisolone for COPD exacerbations in our case raises the question why and how the last steroid regimen provoked SHS. SHS can present with multiple gastrointestinal symptoms including ileus and the absence of eosinophilia during the whole course of the disease should not lower the level of suspicion in the appropriate clinical setting.
我们报告了一例来自肯尼亚的移民发生的致命性粪类圆线虫高度感染综合征（SHS）病例，该患者已在德国生活了三十年。在出现症状前四周，患者因慢性阻塞性肺疾病（COPD）急性加重接受了短期口服类固醇治疗。最初的临床和影像学检查结果提示机械性小肠梗阻是肠梗阻的病因。我们的病例强调，即使来自流行地区的患者离开原籍国数年，对其类圆线虫病保持高度怀疑指数仍很重要。它表明，即使是为期五天的泼尼松龙疗程也能够在患有潜在类圆线虫病的患者中引发SHS。在我们的病例中，患者既往因COPD急性加重频繁口服泼尼松龙的病史引发了一个问题，即为何以及最后一次类固醇治疗方案如何引发了SHS。SHS可表现为多种胃肠道症状，包括肠梗阻，并且在疾病的整个过程中缺乏嗜酸性粒细胞增多不应在适当的临床环境中降低怀疑程度。
