Abstract：
BACKGROUND: Strongyloidiasis, caused by Strongyloides stercoralis (S. stercoralis), is endemic worldwide, especially in countries with warm and humid climates. Strongyloides stercoralis hyperinfection syndrome (SHS) is an extremely serious manifestation of strongyloidiasis, which results from an acute exacerbation of auto-infection and is often fatal.
METHODS: We present a case of SHS mimicking pseudomembranous enteritis with a final definitive diagnosis of a triple infection including S. stercoralis, Escherchia coli (E. coli) and Pneumocytis jirovecii (P. jirovecii) that occurred in a microscopic polyangiitis (MPA) patient after immunosuppressive therapy. SHS, together with E. coli bacteremia and Pneumocytis jirovecii pneumonia (PJP) in the same patient, is rare in clinical practice, which is first reported worldwide, to our knowledge. After the diagnosis was confirmed, the treatment protocol was quickly adjusted; however, the patient\'s life could not be saved.
CONCLUSIONS: This case reminds us of the necessity to consider strongyloidiasis as a differential diagnosis in immunocompromised populations who live in or have visited to S. stercoralis endemic areas, especially patients with suspected pseudomembranous enteritis, even if stool examination, serological tests, and eosinophilia are negative. For this group, it is advisable to complete the relevant endoscopy and/or PCR as soon as possible. The fundamental solution to prevent this catastrophic outcome is to implement effective preventive measures at multiple levels, including physicians, patients, and relevant authorities.
METHODS: We present a case of SHS mimicking pseudomembranous enteritis with a final definitive diagnosis of a triple infection including S. stercoralis, Escherchia coli (E. coli) and Pneumocytis jirovecii (P. jirovecii) that occurred in a microscopic polyangiitis (MPA) patient after immunosuppressive therapy. SHS, together with E. coli bacteremia and Pneumocytis jirovecii pneumonia (PJP) in the same patient, is rare in clinical practice, which is first reported worldwide, to our knowledge. After the diagnosis was confirmed, the treatment protocol was quickly adjusted; however, the patient\'s life could not be saved.
CONCLUSIONS: This case reminds us of the necessity to consider strongyloidiasis as a differential diagnosis in immunocompromised populations who live in or have visited to S. stercoralis endemic areas, especially patients with suspected pseudomembranous enteritis, even if stool examination, serological tests, and eosinophilia are negative. For this group, it is advisable to complete the relevant endoscopy and/or PCR as soon as possible. The fundamental solution to prevent this catastrophic outcome is to implement effective preventive measures at multiple levels, including physicians, patients, and relevant authorities.
摘要：
背景：网虫病，由骨圆圆线虫(S.胸骨)，是全世界的地方病，特别是在气候温暖潮湿的国家。胸圆线虫高度感染综合征(SHS)是一种极其严重的表现,这是由自身感染的急性加重引起的，通常是致命的。
方法：我们介绍了一例模仿假膜性肠炎的SHS，最终明确诊断为包括胸骨链球菌在内的三重感染，大肠杆菌(E.大肠杆菌)和Jirovecii肺炎(P.jirovecii）发生在免疫抑制治疗后的显微镜下多血管炎（MPA）患者中。SHS,在同一患者中，大肠杆菌菌血症和肺炎肺炎（PJP），在临床实践中很少见，这是在世界范围内首次报道的，我们的知识。确诊后,治疗方案迅速调整;然而,病人的生命无法挽救。
结论：此例病例提醒我们，对于生活在或曾去过胸骨链球菌流行区的免疫功能低下人群，必须考虑将线虫病作为鉴别诊断，尤其是疑似假膜性肠炎的患者，即使大便检查,血清学试验,嗜酸性粒细胞增多呈阴性.对于这个群体来说,建议尽快完成相关的内窥镜检查和/或PCR。防止这种灾难性后果的根本解决办法是在多个层面实施有效的预防措施,包括医生,病人,和有关当局。
方法：我们介绍了一例模仿假膜性肠炎的SHS，最终明确诊断为包括胸骨链球菌在内的三重感染，大肠杆菌(E.大肠杆菌)和Jirovecii肺炎(P.jirovecii）发生在免疫抑制治疗后的显微镜下多血管炎（MPA）患者中。SHS,在同一患者中，大肠杆菌菌血症和肺炎肺炎（PJP），在临床实践中很少见，这是在世界范围内首次报道的，我们的知识。确诊后,治疗方案迅速调整;然而,病人的生命无法挽救。
结论：此例病例提醒我们，对于生活在或曾去过胸骨链球菌流行区的免疫功能低下人群，必须考虑将线虫病作为鉴别诊断，尤其是疑似假膜性肠炎的患者，即使大便检查,血清学试验,嗜酸性粒细胞增多呈阴性.对于这个群体来说,建议尽快完成相关的内窥镜检查和/或PCR。防止这种灾难性后果的根本解决办法是在多个层面实施有效的预防措施,包括医生,病人,和有关当局。
