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Strongyloides hyperinfection — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesStrongyloides hyperinfectionSCE Acute Medicine

A 42-year-old man presents with fever, systemic upset and acute deterioration. Relevant history includes a plausible infectious exposure or immunocompromising context. On assessment, NEWS2 is elevated and there are features of organ dysfunction. Investigations show steroid exposure, wheeze, ileus, larvae in sputum and Gram-negative sepsis. What is the most likely underlying cause/mechanism?

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Correct answer: E — Corticosteroid-triggered Strongyloides hyperinfection

The key discriminator is that steroid exposure, wheeze, ileus, larvae in sputum and Gram-negative sepsis, which makes Corticosteroid-triggered Strongyloides hyperinfection the single best answer. Drug-induced renal tubular injury is less appropriate because it does not address the dominant acute risk in the vignette; Adrenal steroid deficiency would fit a different presentation or later stage of care. Defective neuromuscular transmission and Right ventricular pressure overload are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: British Infection Association guidance