Strongyloides stercoralis hyperinfection with shock and thrombosis

Strongyloides stercoralis (SS) is an intestinal parasite that can cause chronic asymptomatic infections, but in rare cases, it can progress to hyperinfection syndrome (SHS). This report describes a case of SHS associated with deep vein thrombosis and pulmonary thromboembolism, a rare manifestation in an immunocompetent patient. A 19-year-old female patient with a 15-day history of abdominal pain, progressive edema of the lower limbs, hemoptotic cough, asthenia, and weight loss. During her hospitalization, she developed sudden dyspnea, desaturation, and distributive shock, requiring invasive mechanical ventilation. Pulmonary angiotomography showed pulmonary thromboembolism, and deep vein thrombosis was diagnosed. Bronchoscopy revealed alveolar hemorrhage, while bronchoalveolar and duodenal lavage confirmed the presence of SS. Ivermectin and albendazole were started with full-dose anticoagulation for the thrombotic event. After one week of management, bronchoalveolar lavage results were negative, and the patient showed significant improvement with no long-term complications. SHS is rare in immunocompetent patients, and its association with thrombosis has been poorly documented in the literature. This case emphasizes the importance of early diagnosis and timely management to avoid life-threatening complications. It also highlights the need for surveillance in endemic regions and the appropriate use of evidence-based therapeutic strategies.