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Strongyloidiasis before immunosuppression — ABIM Board MCQ

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HardInfectious DiseaseStrongyloidiasis before immunosuppressionABIM Board

A 52-year-old man from rural Cambodia is about to start high-dose prednisone for presumed eosinophilic granulomatosis with polyangiitis. He has intermittent abdominal pain, eosinophilia, and a serpiginous perianal rash. Which of the following is the most likely cause?

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Correct answer: B — Strongyloides stercoralis autoinfection

Strongyloides can persist for decades through autoinfection and may cause hyperinfection when corticosteroids are started. Screening and empiric ivermectin are important when epidemiologic risk and eosinophilia are present.

Reference: CDC Strongyloides Guidance; IDSA Parasitic Infection Guidance