Strongyloidiasis With Severe Malnourishment and Hyponatremia After Suboptimal Antihelminthic Therapy: A Case Report and Review of the Literature

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We report a 73-year-old woman from Dominica with anorexia and weight loss who was found to have strongyloides infection on esophagogastroduodenoscopy and subsequently was treated with 40 μg/kg of ivermectin for 2 days, although most experts recommend 200 μg/kg. An incidental stage 1 endometrial carcinoma was found, and hysterectomy was performed with postoperative dexamethasone for nausea. Her vomiting worsened, and she re-presented to the hospital with anasarca, severe hyponatremia, and oral intolerance. The syndrome of inappropriate antidiuretic hormone secretion was suspected based on elevated urine osmolarity and nonresponse to intravenous normal saline. Repeat endoscopy demonstrated severe duodenitis with ulcerations, and biopsy confirmed a high burden of strongyloidiasis. She was treated with ivermectin at 200 μg/kg daily for 7 days with complete symptom resolution. High suspicion for strongyloides infection should be exercised for patients from endemic areas with chronic gastrointestinal symptoms, wheezing, and/or hypereosinophilia, and corticosteroids must be avoided to prevent dissemination.

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