Case Report: mNGS-negative Strongyloides hyperinfection syndrome with small bowel obstruction as the initial manifestation in a glucocorticoid-exposed COPD patient: a fatal case
- 1Department of Clinical Laboratory, The Second Affiliated Hospital of Xiamen Medical College
Abstract
Background: Strongyloides hyperinfection syndrome (SHS) is a life-threatening condition in immunocompromised hosts with an extremely high mortality rate. Metagenomic next-generation sequencing (mNGS) demonstrates limited sensitivity for parasitic detection, and its clinical value remains to be fully elucidated. The conventional microscopy remains an indispensable tool for the diagnosis of parasitic infections.
Case description: A 73-year-old male patient with a history of chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, and cerebral infarction presented with abdominal pain and distension for 7 days and no bowel movement for 3 days. He was diagnosed with incomplete small bowel obstruction at an outside hospital and treated with fasting, enemas, meropenem, and methylprednisolone. He was subsequently transferred to our hospital due to acute lower respiratory tract infection. Chest radiography revealed bilateral diffuse infiltrates, and his condition rapidly deteriorated, requiring admission to the intensive care unit (ICU), endotracheal intubation, mechanical ventilation, and continuous renal replacement therapy (CRRT). Stool smear and retrospective sputum examination both identified larvae of Strongyloides stercoralis. However, mNGS of sputum and bronchoalveolar lavage fluid (BALF) obtained upon admission failed to detect any parasitic sequences. The patient was treated sequentially with albendazole and ivermectin, in combination with broad-spectrum antibacterial, antifungal, and antiviral therapy. He ultimately died on February 11, 2025, due to severe pneumonia, sepsis, and bone marrow suppression.
Conclusion: For immunocompromised hosts with multiple risk factors, particularly those exposed to glucocorticoids, active parasitic microscopic examination of stool and respiratory secretions should be pursued when unexplained pulmonary infiltrates coexist with gastrointestinal symptoms, even in the setting of negative mNGS results, to avoid missed diagnosis.
Related
- The Strongyloides stercoralis nervous system
- Study 9 — The Okinawa Natural Experiment: Strongyloides Eradication, HTLV-1 Suppression, and ATL Decline
- Serodiagnosis of Human Strongyloidiasis in Brazil and Peru Using Strongyloides venezuelensis Antigens: A Comparative Study in Endemic Settings.
- Clearance of Strongyloides stercoralis infection using ivermectin improves kidney function and modulates untargeted urinary metabolomic profile in patients with early-stage chronic kidney disease
- Prevalence of Strongyloides stercoralis infection among African children: A systematic review and meta-analysis
BibTeX
@article{su2026case,
title = {{Case Report: mNGS-negative Strongyloides hyperinfection syndrome with small bowel obstruction as the initial manifestation in a glucocorticoid-exposed COPD patient: a fatal case}},
author = {Jiaqi Su and Yingying Lu and Yuanzhi Xia and Chunhong Xie and Jinyan Kai and Lianjiang Huang},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1940986},
url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1940986/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Case Report: mNGS-negative Strongyloides hyperinfection syndrome with small bowel obstruction as the initial manifestation in a glucocorticoid-exposed COPD patient: a fatal case
AU - Jiaqi Su
AU - Yingying Lu
AU - Yuanzhi Xia
AU - Chunhong Xie
AU - Jinyan Kai
AU - Lianjiang Huang
PY - 2026
DA - 2026/10/06
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1940986
UR - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1940986/full
AB - Background: Strongyloides hyperinfection syndrome (SHS) is a life-threatening condition in immunocompromised hosts with an extremely high mortality rate. Metagenomic next-generation sequencing (mNGS) demonstrates limited sensitivity for parasitic detection, and its clinical value remains to be fully elucidated. The conventional microscopy remains an indispensable tool for the diagnosis of parasitic infections. Case description: A 73-year-old male patient with a history of chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, and cerebral infarction presented with abdominal pain and distension for 7 days and no bowel movement for 3 days. He was diagnosed with incomplete small bowel obstruction at an outside hospital and treated with fasting, enemas, meropenem, and methylprednisolone. He was subsequently transferred to our hospital due to acute lower respiratory tract infection. Chest radiography revealed bilateral diffuse infiltrates, and his condition rapidly deteriorated, requiring admission to the intensive care unit (ICU), endotracheal intubation, mechanical ventilation, and continuous renal replacement therapy (CRRT). Stool smear and retrospective sputum examination both identified larvae of Strongyloides stercoralis. However, mNGS of sputum and bronchoalveolar lavage fluid (BALF) obtained upon admission failed to detect any parasitic sequences. The patient was treated sequentially with albendazole and ivermectin, in combination with broad-spectrum antibacterial, antifungal, and antiviral therapy. He ultimately died on February 11, 2025, due to severe pneumonia, sepsis, and bone marrow suppression. Conclusion: For immunocompromised hosts with multiple risk factors, particularly those exposed to glucocorticoids, active parasitic microscopic examination of stool and respiratory secretions should be pursued when unexplained pulmonary infiltrates coexist with gastrointestinal symptoms, even in the setting of negative mNGS results, to avoid missed diagnosis.
SN - 1664-3224
ER -