Worms on the brain: fatal meningoencephalitis from disseminated strongyloides infection.

Severe, complicated Strongyloides infection can lead to bacterial sepsis and meningitis. We report a case of Strongyloides meningoencephalitis complicating steroid treatment for presumptive asthma. Following a patient's seizure, analysis of cerebrospinal fluid (CSF) revealed numerous Strongyloides worms (filariaform larvae). The finding of threadworms within the central nervous system (CNS) is exceptionally rare. Seven days of ivermectin therapy with subsequent lumbar puncture revealed the organisms were eradicated from the CNS. Unfortunately, the patient never recovered neurologic function and expired after supportive care was withdrawn.