Fatal dissemination of Strongyloides stercoralis in an HIV-positive patient with preserved immunity: a case report

We report the case of a 38-year-old woman with human immunodeficiency virus (HIV) infection diagnosed in 2010 and on antiretroviral treatment since 2014, with an undetectable viral load and a CD4 lymphocyte count of 527 cells/µL. The patient presented with weight loss, fever, hyporexia, nausea, vomiting, progressive dyspnea, purpuric abdominal lesions, and lower extremity edema. During hospitalization, she developed hemoptysis and severe respiratory failure and died a few hours later. Parasitological studies of sputum and stool showed abundant Strongyloides stercoralis larvae, confirming disseminated strongyloidiasis. This case highlights that severe S. stercoralis infection can occur even in patients with clinically controlled HIV, underscoring the need for screening in endemic regions.