title: Syndrome of Inappropriate Anti-Diuretic Hormone Secretion Secondary to Strongyloides stercoralis Infection in an Allogeneic Stem Cell Transplant Patient: A Case Report and Literature Review.
abstract: Syndrome of inappropriate anti-diuretic hormone (SIADH) has been reported to be associated with systemic Strongyloides stercoralis. Here, we report a case of a stem cell transplant (SCT) recipient who developed severe SIADH secondary to systemic S Stercoralis. The SIADH resolved quickly after treating the systemic S Stercoralis with ivermectin. A systematic review of the literature was performed by PubMed, Scopus, and Cochrane database search. Only eight cases of S Stercoralis in allogeneic SCT recipients have been previously reported. To our knowledge, ours is the first reported case of SIADH secondary to S Stercoralis infection in an allogeneic SCT recipient. Prior to transplantation, even if asymptomatic, patients from endemic regions should be screened with strongyloides immunoglobulin (Ig)G serology. Pretransplantation eosinophilia should be evaluated by screening multiple stool samples for ova and parasites. Transplant candidates with positive serology or stool tests can be treated pretransplantation to eradicate infection. Patients at risk for S Stercoralis who develop nonspecific gastrointestinal complaints, rash, pulmonary infiltrates, or gram-negative bacteremia or meningitis may have S Stercoralis hyperinfection syndrome. Our case indicates that the development of SIADH may be an additional clue to this diagnosis. Appropriate diagnostic studies, including repeat stool and other body fluid sampling, should be expedited and ivermectin therapy initiated rapidly to prevent significant morbidity and mortality.
authors.affiliation: The University of South Alabama, Mitchell Cancer Institute, Mobile, Alabama, USA. Electronic address: mmkhushman@health.southalabama.edu.
authors.forename: M
authors.initials: M
authors.lastname: Khushman
authors.affiliation: Infectious Diseases, The University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: M I
authors.initials: MI
authors.lastname: Morris
authors.affiliation: Internal Medicine, The University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: L
authors.initials: L
authors.lastname: Diaz
authors.affiliation: Adult Stem Cell Transplant Program, The University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
authors.forename: M
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Adult Stem Cell Transplant Program, The University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
authors.forename: D
authors.initials: D
authors.lastname: Pereira
authors.affiliation: Adult Stem Cell Transplant Program, The University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
authors.forename: K
authors.initials: K
authors.lastname: Fuller
authors.affiliation: Pathology, The University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: M
authors.initials: M
authors.lastname: Garcia-Buitrago
authors.affiliation: Gastroenterology, The University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: B
authors.initials: B
authors.lastname: Moshiree
authors.affiliation: Nephrology, The University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: S
authors.initials: S
authors.lastname: Zelaya
authors.affiliation: Nephrology, The University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: A
authors.initials: A
authors.lastname: Nayer
authors.affiliation: Adult Stem Cell Transplant Program, The University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Benjamin
authors.affiliation: Adult Stem Cell Transplant Program, The University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
authors.forename: K V
authors.initials: KV
authors.lastname: Komanduri
mesh_terms: D000368:Aged; D000818:Animals; D000969:Antinematodal Agents / Q000009:adverse effects / Q000627:therapeutic use; D004378:Duodenal Diseases / Q000188:drug therapy / Q000469:parasitology*; D004802:Eosinophilia / Q000469:parasitology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007177:Inappropriate ADH Syndrome / Q000469:parasitology*; D007559:Ivermectin / Q000627:therapeutic use; D008297:Male; D009894:Opportunistic Infections / Q000150:complications* / Q000188:drug therapy; D011183:Postoperative Complications / Q000188:drug therapy / Q000469:parasitology; D033581:Stem Cell Transplantation; D017171:Strongyloides stercoralis; D013322:Strongyloidiasis / Q000150:complications*; D014184:Transplantation, Homologous
chemical_list: D000969:Antinematodal Agents; D007074:Immunoglobulin G; D007559:Ivermectin