Abstract：
Strongyloidiasis is a gastrointestinal parasitic infection caused by percutaneous infection with Strongyloides stercoralis, which is mainly distributed in the tropics and subtropics worldwide. Digestive symptoms like diarrhea and abdominal pain are the main manifestation, but serious infections such as bacterial pneumonia, purulent meningitis and sepsis also occur in immunocompromised individuals. Herein, we present a rare case of a type II diabetes mellitus (T2DM) patient presented with gastrointestinal hemorrhage and sepsis caused by concomitant Strongyloides stercoralis and cytomegalovirus (CMV) infection. This 51-year-old male patient presented to the hospital with vomiting, diarrhea, dyspnea, palpitation and weakness. Examination revealed skin soft-tissue infection with T2DM, and upper endoscopy revealed gastric mucosal erosion and hemorrhage. Radiology revealed bilateral diffuse interstitial infiltrates and thickened walls of the colon. Importantly, stool and vomitus examination showed numerous larvae of Strongyloides stercoralis. Then the diagnosis of Strongyloides hyperinfection syndrome was made. But antibiotics and albendazole treatment did not improve the patient\'s symptoms of gastrointestinal bleeding and sepsis. Subsequently, other pathogens were screened by sequence and a positive CMV gene was found in the peripheral blood. Thus, antibiotics, albendazole and ganciclovir were all used which ultimately resolved the infection in this patient. Therefore, this case indicated CMV could also by co-infected with Strongyloides stercoralis in the immunocompromised patient, which remind us that an CMV test should also be performed when encountered in severe strongyloidiasis infection, which could improve the prognosis of the patient.
摘要：
Strongyionasis是一种胃肠道寄生虫感染引起的经皮感染，主要分布在全球热带和亚热带。腹泻和腹痛等消化症状是主要表现，但严重的感染如细菌性肺炎,化脓性脑膜炎和败血症也发生在免疫功能低下的个体中。在这里，我们介绍了一例罕见的2型糖尿病(T2DM)患者,其表现为胃肠道出血和败血症,并由同时存在的类圆线虫和巨细胞病毒(CMV)感染引起.这位51岁的男性患者因呕吐而出现在医院，腹泻,呼吸困难,心悸和虚弱。检查提示皮肤软组织感染伴T2DM，上消化道内镜显示胃黏膜糜烂及出血。放射学显示双侧弥漫性间质浸润和结肠壁增厚。重要的是,粪便和呕吐物检查显示大量的类圆线虫幼虫。诊断为类圆线虫高度感染综合征。但抗生素和阿苯达唑治疗并不能改善患者消化道出血和脓毒症的症状。随后，通过序列筛选其他病原体，在外周血中发现CMV基因阳性。因此，抗生素,阿苯达唑和更昔洛韦全部使用，最终解决了该患者的感染。因此,该病例表明CMV也可能与免疫功能低下的患者同时感染。这提醒我们，当遇到严重的圆线虫病感染时，也应该进行CMV测试，可以改善患者的预后。
