title: Multiorgan Dysfunction Syndrome from Strongyloides stercoralis Hyperinfection in a Patient with Human T-Cell Lymphotropic Virus-1 Coinfection After Initiation of Ivermectin Treatment.
abstract: Strongyloides stercoralis is well known to cause hyperinfection syndrome during the period of immunosuppression; but dissemination, worsening hyperinfection, and development of multiorgan dysfunction syndrome after initiation of ivermectin has not been reported in the past. Herein, we describe the case of a 62-year-old man with chronic strongyloidiasis and human T-cell lymphotropic virus-1 coinfection, who developed significant clinical worsening after 24-48 hours of initiation of treatment with ivermectin (200 μg/kg daily). Oral albendazole (600 mg every 12 hours) was added to the regimen due to clinical deterioration. Notably, after a protracted clinical course with multiple complications, which included respiratory failure from gram-negative pneumonia and pulmonary alveolar hemorrhage, Klebsiella meningitis, Clostridium difficile colitis, and herpes labialis, the patient eventually recovered. Health-care providers should be aware that during the early days of antihelminthic treatment initiation, significant dissemination of S. stercoralis and worsening of the clinical scenario can occur.
authors.affiliation: Department of Internal Medicine, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania. ttchoksi@hotmail.com.
authors.forename: Tatvam T
authors.initials: TT
authors.lastname: Choksi
authors.affiliation: Department of Infectious Diseases, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania.
authors.forename: Gul
authors.initials: G
authors.lastname: Madison
authors.affiliation: Department of Internal Medicine, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania.
authors.forename: Tawseef
authors.initials: T
authors.lastname: Dar
authors.affiliation: Department of Surgery, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Asif
authors.affiliation: Department of Internal Medicine, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fleming
authors.affiliation: Department of Surgery, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania.
authors.forename: Leon
authors.initials: L
authors.lastname: Clarke
authors.affiliation: Department of Gastroenterology, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania.
authors.forename: Mervyn
authors.initials: M
authors.lastname: Danilewitz
authors.affiliation: Department of Pathology, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania.
authors.forename: Randa
authors.initials: R
authors.lastname: Hennawy
mesh_terms: D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000977:Antiparasitic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D060085:Coinfection; D004761:Enterocolitis, Pseudomembranous / Q000150:complications; D016905:Gram-Negative Bacterial Infections / Q000150:complications; D015490:HTLV-I Infections / Q000150:complications*; D006560:Herpes Labialis / Q000150:complications; D015368:Human T-lymphotropic virus 1; D006801:Humans; D007559:Ivermectin / Q000009:adverse effects* / Q000627:therapeutic use; D007710:Klebsiella Infections / Q000150:complications; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D018410:Pneumonia, Bacterial / Q000150:complications; D012131:Respiratory Insufficiency / Q000150:complications; D017171:Strongyloides stercoralis; D013322:Strongyloidiasis / Q000150:complications / Q000188:drug therapy*
chemical_list: D000977:Antiparasitic Agents; D007559:Ivermectin; D015766:Albendazole