Multimorbid woman in her sixties with abdominal pain and dark stools

Background: A middle-aged woman was admitted to hospital several times in a period of six weeks where the underlying cause of her symptoms was related to a disease rarely seen in Norwegian hospitals. Case presentation: The patient was born and raised in Southeast Asia, but had lived in Norway since the 1970s. She was prescribed occasional courses of prednisolone for gout. The patient presented at hospital with abdominal pain. Examinations revealed gastrointestinal bleeding, metabolic acidosis and gram-negative sepsis. However, a ventricular biopsy revealed an underlying aetiology of Strongyloides stercoralis larvae. Interpretation: Strongyloidiasis is an infection caused by the intestinal nematode Strongyloides stercoralis. Transmission mainly occurs in tropical and subtropical areas, and the primary mode of infection is through larvae penetrating the skin. The parasite has a complex life cycle and, due to autoinfection, an infected person can have an active infection for several decades after leaving an endemic area. Subsequent impairment of host immunity can lead to accelerated autoinfection and cause hyperinfection, which could be fatal if left untreated. Before initiating immunosuppressive therapy, all patients should be considered for serological screening for strongyloidiasis, regardless of the time since possible exposure.