Steroid-induced Strongyloidiasis with Cholestasis Post-COVID-19 Pneumonia

Abstract

The use of immunosuppressive agents has recently been raised during the COVID-19 pandemic to manage the COVID-19-induced systemic inflammatory response and improve mortality. This widespread use of steroids and other immunomodulators for severe COVID-19 diseases might pose a potential risk of reactivation of latent diseases and the emergence of opportunistic infections such as strongyloidiasis. We report a case of strongyloidiasis with cholestasis in a middle-aged man; who was otherwise healthy and had no history of recent travel, developed three weeks after a prolonged course of steroids for the management of severe COVID-19 pneumonia. The patient was managed with a combination of albendazole and ivermectin. A high index of suspicion of strongyloidiasis in symptomatic patients post immunosuppressant therapy for severe COVID-19 is required to prevent unfavorable outcomes. In selected high-risk patients, post prolonged steroid therapy for COVID-19 pneumonia screening for strongyloidiasis and ivermectin empirical treatment might be considered even in non-endemic areas.

Steroid therapy in COVID-19 as a triggering factor for Strongyloides stercoralis hyperinfection

“…A case of strongyloidiasis triggered by steroid use in the treatment of COVID-19 in Oman was described by Busaidi et al (2022). The researchers report that a 55-year-old patient, hospitalized in April 2020 for acute SARS-CoV-2 pneumonia, received treatment with Dexamethasone for five days during hospitalization and follow-up of corticosteroid use for five weeks in the convalescence period.…”