Fatal strongyloides hyperinfection syndrome in a chronic steroid user: A case report

AbstractStrongyloides stercoralis is an intestinal nematode capable of lifelong autoinfection, typically asymptomatic in immunocompetent individuals but potentially leading to life-threatening Strongyloides hyperinfection syndrome (SHS) in immunosuppressed patients, especially with corticosteroid use. We present a fatal case of SHS in a 28-year-old Ethiopian man with chronic, unsupervised corticosteroid use for tophaceous gout. He developed gastrointestinal symptoms, deteriorated despite supportive care, and succumbed to septic shock. A gastric biopsy performed postmortem confirmed Strongyloides stercoralis. This case underscores the diagnostic challenges of SHS in resource-limited settings, the role of steroid-induced immunosuppression, and the importance of early screening or empirical treatment in high-risk patients to improve outcomes.