A case of disseminated strongyloidiasis after multiple courses of immunosuppression

摘要

A 71-year-old man presented to the emergency department with a 4-month history of weight loss, anorexia and constipation, and a 2-week history of abdominal pain. He had biopsy-proven immunoglobulin G4 (lgG4)-related disease involving the pancreas and kidneys with 2 episodes of Gramnegative bacteremia over the past 3 years. The first episode was attributed to cholangitis and the second to a suspected obstructive pancreatic cancer. For these reasons, he underwent a cholecystectomy and Roux-en-Y hepaticojejunostomy; no cancer was found. During the previous 3 years, he had received multiple courses of immunosuppressive medications for flares of lgG4-related disease, including rituximab, mycophenolate mofetil and many courses of high-dose steroids (Figure 1). About 1 month before presentation, he had been started on high-dose steroids to treat a flare of lgG4-related disease causing acute kidney injury. He had immigrated from China 40 years earlier and had not travelled recently.