Hyperinfection by Strongyloides stercoralis probably associated with Rituximab in a patient with mantle cell lymphoma and hyper eosinophilia

Abstract

SUMMARYThe first report to our knowledge, of hyperinfection by Strongyloides stercoralis (HS) and hypereosinophilia, associated to immune suppression by Rituximab (the only drug received for the last one year and 10 months), in a patient with mantle-cell lymphoma (MCL), is presented. The patient has a 3-year history of MCL, and developed two accesses of HS during 2008, including meningitis, pneumonia and presence of larvae of S. stercoralis in the lungs. We had a unique chance to look at cytotoxicity of filariform larvae in the expectoration after Ivermectin treatment, showing immobilization and death of larvae, associated with eosinophils attached to the cuticle of the parasite.

Histopathological diagnosis of strongyloidiasis hyperinfection in Tunisian patient with hodgkin lymphoma: Case report

“…Similar to our case who was associated with Hodgkin lymphoma under treatment, other cases have been diagnosed in association with hematologic malignancy [ [9] , [10] , [11] ]. Adam et al [ 10 ] reported three cases of hyperinfection associated with lymphoma (one of them was classic Hodgkin lymphoma) treated with M.O.P.P.…”

“…Most authors link hyperinfection in hematologic malignancy to the use of glucosteroids [ 1 , 2 , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. However, Incani [ 2 ] suggested a relationship between hyperinfection and Rituximab.…”

Perforated Acute Abdomen in a Immunossuppressed Patient due to Strongyloides stercoralis Hyperinfection Syndrome

“…The pathogenesis occurs when the reinfection cycle begins and the parasitic intraluminal load increases. The filariform larvae of S. stercoralis invade the intestinal walls and can spread through the lymphatic and hematogenous pathways to distant organs, such as liver, pancreas, lungs and central nervous system, triggering an intense multisystemic inflammatory response (5,11,12). This hyperinfection is usually accompanied by Gramnegative septicemia somehow facilitated by infectious filariform larvae through the intestinal mucosa, leading to high mortality rates (3,6).…”

“…These infirms often present severe and refractory sepsis with unfavorable outcomes. (3,5) The diagnosis of strongyloidiasis is based on the microscopic identification of larvae (rhabditiform and occasionally filariform) in the stool or duodenal fluid. However, their presence in histopathological analyses has increased in recent years due to the large amount of hyperinfection cases in immunocompromised patients.…”

Strongyloidiasis complicating immunosuppression for pemphigus vulgaris

“…Other immunosuppressants, including biological agents, may also predispose to hyperinfection . Interestingly, rituximab, which is increasingly used to manage PV, was implicated in the death of a Brazilian patient with Strongyloides hyperinfection …”