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Case Reports in Infectious Diseases
Volume 2013, Article ID 424362, 4 pages
http://dx.doi.org/10.1155/2013/424362
Case Report

E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis

1Department of Internal Medicine, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
2Grupo de Investigacion en Inmunologia, Universidad Nacional de San Agustin, Arequipa, Peru
3Department of Neurology, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
4Department of Pathology, Guillermo Almenara Irigoyen National Hospital, Lima, Peru

Received 8 August 2013; Accepted 7 October 2013

Academic Editors: L. M. Bush, A. Marangoni, and B. Moreira

Copyright © 2013 Juliana B. Gomez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell’s palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β-lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.