Strongyloides stercoralis Autoinfection

To the Editor.— A case of asymptomatic Strongyloides stercoralis autoinfection with marked eosinophilia appeared in a patient absent from endemic areas for 23 years. Report of a Case.— A 37-year-old Puerto Rican man had departed from Puerto Rico at age 14 years, and has lived continuously in New York city since. On admission, he admitted to heavy alcohol consumption and complained of vomiting, weakness, icterus, and increasing abdominal girth. Abnormal physical findings included a liver palpable 7 cm below the right costal margin, and pedal edema (2+) bilaterally. The white blood cell count (WBC) was 8,200/cu mm, with 84% neutrophils, 14% lymphocytes, 2% monocytes, and no eosinophils. The patient was treated with fluids intravenously and all laboratory data returned to normal. A liver biopsy revealed cirrhosis and alcoholic hepatitis. The patient became asymptomatic and afebrile and was given a seven-day course of ampicillin (250 mg by mouth every six hours)