# Successful Prompt Diagnosis of Strongyloidiasis in an Outpatient Setting at Amami Oshima Island in Japan: A Case Report

## TL;DR

A 92-year-old woman in Japan was successfully diagnosed with strongyloidiasis using a non-invasive stool test and treated with ivermectin.

## Contribution

Demonstrates successful non-invasive diagnosis of strongyloidiasis in a patient refusing invasive tests.

## Key findings

- Agar plate culture of a stool sample confirmed strongyloidiasis in a patient with protein-losing gastroenteropathy-like symptoms.
- Ivermectin treatment led to improvement in leg edema and hypoproteinemia within a month.
- Physicians should consider strongyloidiasis in patients from tropical/subtropical regions with unexplained symptoms.

## Abstract

Strongyloidiasis is a parasitic infection caused by the nematode Strongyloides stercoralis that presents with a variety of nonspecific symptoms. Diagnosis is challenging unless physicians suspect this disease and perform sensitivity tests. We report a case of strongyloidiasis with protein-losing gastroenteropathy-like symptoms in a 92-year-old Japanese female with lower extremity edema and hypoalbuminemia. In this case, the patient refused invasive tests for a complete examination; however, an agar plate culture of a stool sample was used to diagnose strongyloidiasis. The patient was treated with ivermectin during the second visit. One month later, leg edema and hypoproteinemia improved. When the cause of the symptoms is unclear, physicians should be aware of the possibility of strongyloidiasis in a person residing in a tropical or subtropical environment, where human feces are used as fertilizer and individuals frequently go barefoot in agricultural settings.