Fatal Disseminated Strongyloidiasis in a Patient With Untreated HIV: A Diagnostic Challenge.

Strongyloides stercoralis hyperinfection carries near-universal mortality if untreated. We present a 52-year-old man from Central America with advanced HIV (CD4 196 cells/μL) who presented with chronic diarrhea, vomiting, and weight loss. Cross-sectional imaging revealed small bowel thickening. Endoscopy demonstrated gastric and duodenal mucosal friability and ulceration. His course was complicated by polymicrobial Gram-negative bacteremia and meningitis. Retrospective identification of antecedent eosinophilia prompted suspicion for Strongyloides, confirmed on intestinal biopsies. The patient died before treatment could be initiated. This case underscores the importance of early clinical suspicion and empiric treatment in high-risk patients.