Management of Strongyloides stercoralis extensive infestation in a patient with Sjogren syndrome

A rare case report of serious, relapsing, and difficult-to-treat Strongyloides stercoralis enteric infestation that occurred in a patient affected by the autoimmune Sjögren disease (a pathologic association never reported before), chronically treated with corticosteroids, has been presented and evaluated on the ground of the available literature evidences in this field. In particular, the role of underlying (and iatrogenic) immunodeficiency in the pathogenesis of S. stercoralis persisting infection and the unresolved diagnostic and therapeutic issues in the setting of strongyloidiasis are discussed. Particular attention is focused on the need to maintain clinical suspicion for this nematode worm infestation in patients suffering from a large spectrum of collagen vascular diseases, and the need for randomized clinical trials to determine suitable first-line and subsequent lines of treatment, especially when immunodeficiency and a relapsing Strongyloides disease are suspected. © 2006 Lippincott Williams & Wilkins, Inc.