title: Fatal septicemic shock associated with Strongyloides stercoralis infection in a patient with angioimmunoblastic T-cell lymphoma: a case report and literature review.
abstract: BACKGROUND
  Strongyloides stercoralis infection can persist in the host for several decades, and patients with cancer and other clinical conditions who are exposed to immunosuppressive therapy are at risk of developing hyperinfection.
  
  
  METHODS
  This is a case of angioimmunoblastic T-cell lymphoma (AITL) in a patient with lymphadenopathy and bulky neck mass. Severe sepsis and episodes of diarrhea were observed upon the first cycle of cyclophosphamide, doxorubicin, oncovin (vincristine) and prednisone (CHOP) regime chemotherapy preceded by high dose of dexamethasone. There was Klebsiella pneumoniae bacteremia and moderate eosinophilia. Rhabditiform S. stercoralis larvae were observed in the stool, and this was confirmed by real-time PCR. Strongyloides-specific IgG and IgG4 were also positive. The patient was treated with oral albendazole (400mg/day) for 3 days and intravenous tazocin (4.5gm/6 hours) for 5 days; however he succumbed following multi-organ failure.
  
  
  CONCLUSIONS
  This is likely a case of Strongyloides hyperinfection with secondary bacteremia.
authors.affiliation: Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Abdelrahman
authors.forename: M
authors.initials: M
authors.lastname: Zeehaida
authors.forename: N
authors.initials: N
authors.lastname: Rahmah
authors.forename: A
authors.initials: A
authors.lastname: Norsyahida
authors.forename: B
authors.initials: B
authors.lastname: Madihah
authors.forename: H
authors.initials: H
authors.lastname: Azlan
authors.forename: W Z
authors.initials: WZ
authors.lastname: Nazlee
mesh_terms: D000368:Aged; D000818:Animals; D003520:Cyclophosphamide / Q000627:therapeutic use; D003967:Diarrhea / Q000150:complications / Q000469:parasitology / Q000503:physiopathology; D004317:Doxorubicin / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D007119:Immunoblastic Lymphadenopathy / Q000150:complications / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology*; D007275:Injections, Intravenous; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D012772:Shock, Septic / Q000150:complications / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology*; D017171:Strongyloides stercoralis / Q000254:growth & development / Q000472:pathogenicity; D013322:Strongyloidiasis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone