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November 1984

Strongyloides stercoralis Hyperinfection Masquerading as Cerebral Vasculitis

Author Affiliations

From the Infectious Diseases Section, Department of Medicine (Drs Wachter and MacGregor), and the Cerebrovascular Research Center, Department of Neurology (Dr Burke), Hospital of the University of Pennsylvania, Philadelphia. Dr Wachter is now with the University of California Hospital, San Francisco; Dr Burke is now with Michael Reese Hospital, Chicago.

Arch Neurol. 1984;41(11):1213-1216. doi:10.1001/archneur.1984.04050220115030

Strongyloides stercoralis hyperinfection is a unique opportunistic infection in which the nematode disseminates widely to cause a multisystem illness. We treated a patient with systemic lupus erythematosus in whom ileus and fever developed and who later lapsed into coma. A xenon Xe 133 cerebral blood flow study showed a global reduction in flow, compatible with CNS vasculitis. The patient's condition failed to improve with high-dose steroid therapy, but he recovered rapidly after Strongyloides larvae were found in stool and sputum and treatment with thiabendazole was begun. We believe that hyperinfection explained the patient's symptoms and should be considered as a cause of diminished cerebral perfusion and mentation in immunosuppressed patients.

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