Strongyloides steroralis: A case report to manifest the diagnosis and treatment

Abstract

Background: Strongyloides stercoralis is a soil-transmitted intestinal nematode capable of establishing chronic autoinfection, allowing infection to persist for decades. Its nonspecific clinical manifestations and variable presentation often result in delayed diagnosis, particularly in older adults and in endemic regions, where unrecognized infection may progress to severe complications. Case Report: A 78-year-old man presented with progressive bilateral lower-extremity edema lasting four months, accompanied by functional class II dyspnea, fever, chills, night sweats, nausea, lethargy, and an unintentional 20-kg weight loss over eight months. Laboratory and imaging investigations failed to identify a clear etiology, prompting further diagnostic evaluation. Histopathological examination together with stool analysis ultimately confirmed Strongyloides stercoralis infection associated with protein-losing enteropathy. The patient was treated with albendazole for seven days, leading to marked clinical improvement and complete resolution of symptoms during follow-up, with recovery of nutritional status and no evidence of recurrence. Conclusion: This case highlights the diagnostic challenge posed by strongyloidiasis in elderly patients presenting with nonspecific constitutional symptoms and protein-losing enteropathy. Clinicians practicing in endemic settings or caring for individuals with relevant epidemiologic risk factors should maintain a high index of suspicion, even in the absence of classic gastrointestinal manifestations or eosinophilia. Early recognition, appropriate parasitological and histopathological investigations, and timely antiparasitic therapy are essential to achieve favorable outcomes and prevent potentially life-threatening complications, including hyperinfection syndrome and disseminated disease.