03645nas a2200337   4500000000100000008004100001260001200042653003300054653002700087653001200114653001400126653003000140100001200170700002100182700001800203700001700221700001800238700001800256700001500274700001400289700001800303700001600321700001300337700001500350245016200365856008900527300000800616490000700624520266200631022001403293       2022                            d  c12/202210aAdrenocortical insufficiency10aCorticosteroid therapy10aleprosy10aSri Lanka10aStrongyloidis stercoralis1 aMorel R1 aMaddumabandara K1 aAmarasinghe N1 aAmarangani S1 aAmarasinghe A1 aGunathilaka M1 aWathsala G1 aBandara L1 aWijesundara S1 aGunaratne N1 aWaduge R1 aMedagama A00aStrongyloidiasis infection in a borderline lepromatous leprosy patient with adrenocorticoid insufficiency undergoing corticosteroid treatment: a case report.  uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733215/pdf/13256_2022_Article_3673.pdf  a4580 v163 a<p><strong>BACKGROUND: </strong>Strongyloidiasis is a soil-transmitted helminthiasis mainly caused by Strongyloides stercoralis. It is endemic to the tropics and subtropics. Sri Lanka has a 0-1.6% prevalence rate. S. stercoralis infection was identified in a 33-year-old Sri Lankan male patient treated with corticosteroids for borderline lepromatous leprosy with adrenocortical dysfunction.</p>

<p><strong>CASE PRESENTATION: </strong>In March 2020, a 33-year-old Sri Lankan (Sinhalese) male patient presented with watery diarrhea, lower abdominal pain, and post-prandial abdominal fullness. Previously, he was diagnosed with borderline lepromatous leprosy and was treated with rifampicin, clofazimine, and prednisolone 60&nbsp;mg daily since July 2019. After developing gastrointestinal symptoms, he had defaulted leprosy treatment including the prednisolone for 3&nbsp;months. Duodenal biopsy revealed numerous intraepithelial nematodes within the lumina of glands in the duodenum whose appearance favored Strongyloides. Fecal wet smear revealed numerous Strongyloidis&nbsp;stercoralis L1 rhabditiform larvae. Larval tracks were seen in the agar plate culture. L3 filariform larvae of Strongyloidis stercoralis were seen in the Harada-Mori culture. In addition, the short synacthen test revealed adrenocortical insufficiency, and oral hydrocortisone and fludrocortisone were started with albendazole treatment against strongyloidiasis. Fecal wet smear and culture repeated after treatment with albendazole were negative for Strongyloidis&nbsp;stercoralis. The patient was discharged in July 2020 on oral hydrocortisone. One&nbsp;month later his condition was reviewed and the repeated fecal wet smear and agar plate culture was normal. He is being followed up every 3&nbsp;months.</p>

<p><strong>CONCLUSION: </strong>This is the first case of strongyloidiasis diagnosed in a patient with borderline lepromatous leprosy from Sri Lanka. The patient manifested symptoms of strongyloidiasis while on high-dose steroid therapy for his lepromatous reaction. Subsequently, the patient not only discontinued his steroid therapy, but also developed adrenocortical insufficiency as a complication of leprosy. Therefore, although diagnosis of strongyloidiasis was delayed, his subsequent low steroid levels probably protected him from disseminated disease. This is an interesting case where symptomatic strongyloidiasis was diagnosed in a patient who was initially treated with high-dose steroids but subsequently developed adrenocortical insufficiency. We emphasize the need to screen all patients prior to the commencement of immunosuppressive therapy.</p>
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