Disseminated Strongyloidiasis in a World War II Veteran with Metastatic Undifferentiated Carcinoma of Neuroendocrine Type

This case of disseminated strongyloidiasis illustrates the need for a high index of suspicion and effective screening for this pathogen in certain high-risk patient populations before giving immunosuppressive therapy. A complete travel and military history should be obtained. In the United States, persons with a history of military service in endemic areas, emigrants from endemic areas, patients in institutions, and residents of the Southeast should have careful evaluation for strongyloidiasis. Eosinophilia may or may not be present. Stool examinations are not sufficient to rule out the diagnosis. When available, the ELISA screening test for serodiagnosis may be useful. Duodenal aspirates or bronchoalveolar lavage may be necessary to confirm the diagnosis.