Strongyloides stercoralis larvae in the urine of a patient with transitional cell carcinoma of the bladder: a case report

Disseminated infection with Strongyloides stercoralis refers to the massive migration of infective larvae from the gastrointestinal tract to other organs that are not involved in the normal life cycle of the parasite. We describe the case of a Nigerian male with transitional cell carcinoma of the bladder in whom larvae of S. stercoralis was identified in the urine. This report involves a 60-year old male Nigerian presenting to the Urology clinic of the Jos University teaching hospital, Nigeria with disseminated S. stercoralis. The index patient presented with a 5 month history of total haematuria, urinary frequency, urgency, nocturia, straining to pass urine, feeling of incomplete voiding and terminal dribbling. He also had episodes of suprapubic pain. Physical examination revealed a cachexic patient who had mild suprapubic tenderness. Urinary examination showed numerous red blood cells and rhabditiform larvae of S. stercoralis. Abdominal ultrasound revealed a heterogeneous mass in the urinary bladder measuring 4.0 × 3.3 cm. Abdominal computed tomography also showed an irregular mass measuring 4.2 × 3.8 cm with HU of 41 projecting into the bladder from the posterior wall towards the dome. Histology of the biopsy specimen revealed transitional cell carcinoma. The patient was treated with a single dose of oral ivermectin but died 1 week later. Physicians working in areas that are endemic for S. stercoralis should consider investigating immunocompromised patients for S. stercoralis infection given the poor prognosis of disseminated infection in this group of patients.