Successful use of subcutaneous ivermectin for the treatment of<i>Strongyloides stercoralis</i>hyperinfection in the setting of small bowel obstruction and paralytic ileus in the immunocompromised population

Abstract

Severe <i>Strongyloides stercoralis</i>, such as hyperinfection syndrome, carries a high mortality risk. Even with appropriate treatment, patients may experience infectious complications and failure of therapy. Currently, there are no Food and Drug Administration-approved parenteral therapies available for treatment in patients who develop gastrointestinal complications from hyperinfection, including small bowel obstruction. A veterinary form of ivermectin is available as a subcutaneous injection, although current literature in humans is limited. We report on the successful treatment of two surviving immunocompromised patients with <i>S. stercoralis</i> hyperinfection syndrome after prompt recognition and initiation of veterinary subcutaneous ivermectin therapy.