Shiga toxin producing E coli bloodstream infection secondary to Strongyloides penetration through intestinal mucosa

A 51-year-old woman with diabetes, who immigrated to the USA 22 years ago from Laos, was admitted to the hospital for evaluation of fever, abdominal pain, vomiting and diarrhoea. A workup for acute gastroenteritis revealed a positive stool PCR for Shiga toxin-producing Escherichia coli. Two sets of blood cultures drawn at admission were positive for E coli. A review of her previous medical records revealed the presence of eosinophilia, up to 20%, 14 years prior to that was never investigated. Therefore, stool samples were examined and two of three specimens were positive for Strongyloides stercoralis larvae, confirming the diagnosis of Strongyloides hyperinfection syndrome.