Strongyloidiasis hyperinfection in a patient with membranoproliferative glomerulonephritis

A 38-year-old female was diagnosed having membranoproliferative glomerulonephritis three months ago for which she was receiving 40-milligram prednisolone daily. She was admitted with 10 to 12 vomiting episodes per day for three days and epigastric pain. Laboratory investigations were: Haemoglobin- 1.023 mmol/L, total leukocyte count - 9.1 x 10 9 /L, neutrophils-80% (7.2 x 10 9 / L) lymphocytes-18% (1.6 x 10 9 /L), eosinophils - 2% (0.18 x 10 9 /L). Urine examination 4 + Proteinuria, 4-6 leukocytes and 6-8 red cells per high power field. Blood urea nitrogen was 20.3 mmol/L and serum creatinine was 129.7 mmol/L. Liver enzymes and serum electrolytes were normal. ELISA Tests for Human immunodeficiency virus and Hepatitis C virus were negative. Peripheral smear was negative for malarial parasite. Ultrasonography revealed minimal hepatosplenomegaly. Nephrology opinion indicated uraemic gastritis. On fourth post admission day she was irritable, non-cooperative and psychiatry opinion indicated adjustment disorder. Vomiting persisted and on the seventh day she had four to five diarrhoeal episodes, shivering, breathlessness and hypotension. Stool examination was not performed. The patient was given the following injectable drugs -Pantoprazole 40 mg od, Hydrocortisone 100 mg od, Ondensetron 4 mg tds, Ciprofloxacin 500 mg.