Successful use of subcutaneous ivermectin for the treatment of Strongyloides stercoralis hyperinfection in the setting of small bowel obstruction and paralytic ileus in the immunocompromised population

BMJ Case Rep. 2018 Jun 4:2018:bcr2017223138. doi: 10.1136/bcr-2017-223138.

Abstract

Severe Strongyloides stercoralis, such as hyperinfection syndrome, carries a high mortality risk. Even with appropriate treatment, patients may experience infectious complications and failure of therapy. Currently, there are no Food and Drug Administration-approved parenteral therapies available for treatment in patients who develop gastrointestinal complications from hyperinfection, including small bowel obstruction. A veterinary form of ivermectin is available as a subcutaneous injection, although current literature in humans is limited. We report on the successful treatment of two surviving immunocompromised patients with S. stercoralis hyperinfection syndrome after prompt recognition and initiation of veterinary subcutaneous ivermectin therapy.

Keywords: infectious diseases; tropical medicine (infectious disease).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Animals
  • Asthma / complications
  • Asthma / drug therapy*
  • Critical Illness
  • Dexamethasone / adverse effects*
  • Drugs, Investigational / therapeutic use*
  • Female
  • Glucocorticoids / adverse effects*
  • HIV Infections / complications
  • HIV Infections / immunology*
  • Humans
  • Immunocompromised Host*
  • Injections, Subcutaneous
  • Intestinal Diseases, Parasitic
  • Intestinal Obstruction / etiology
  • Intestinal Pseudo-Obstruction / etiology
  • Ivermectin / therapeutic use*
  • Male
  • Strongyloides stercoralis
  • Strongyloidiasis / complications
  • Strongyloidiasis / drug therapy*
  • Strongyloidiasis / immunology

Substances

  • Drugs, Investigational
  • Glucocorticoids
  • Ivermectin
  • Dexamethasone