Fatal pancytopenia due to albendazole treatment for strongyloidiasis

• Reactivation of Strongyloides after immunosuppression is an important consideration especially in endemic area with previous farming activity. • Provision of ivermectin can be limited in developing country. • Although albendazole is generally well tolerated, it may lead to fatal pancytopenia after prolonged exposure or with underlying liver disease. We report 7 cases of strongyloidiasis that had occurred from 2016 through 2017 in a tertiary hospital of southern China. Three of the 7 patients (age 66–77) with farming exposure many years ago developed symptomatic infection while receiving immunosuppressant for underlying medical conditions. The majority of them were treated with albendazole due to unavailability of ivermectin in mainland China. One of the 7 patients, with underlying IgG4 sclerosing cholangitis and secondary biliary cirrhosis was on immunosuppressives and developed severe pancytopenia 15 days after albendazole treatment. He ultimately died of polymicrobial sepsis. This was the second fatal case being reported in the literature as a consequence of albendazole-induced myelosuppression. We have undertaken a review of the literature regarding the use of albendazole for strongyloidiasis and its adverse effect with a focus on myelosuppression as a rare but potentially serious event.