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Strongyloides stercoralis  is an endemic parasitic infection that can remain asymptomatic for years, but it can cause death in immunosuppressed individuals. Here, we present a case of  Strongyloides  hyperinfection in a 75-year-old male secondary to sepsis and chronic immunosuppression due to TNF- α  inhibitors. Despite aggressive treatment including broad-spectrum antibiotics and antihelminths, his respiratory failure worsened and he died after palliative extubation.  S. stercoralis  infection remains a diagnostic challenge. Presentation with  Strongyloides  is often nonspecific, and eosinophilia is absent in hyperinfection. Diagnosis can be delayed, especially in low-prevalence areas where suspicion is low.  Strongyloides  should be considered in the differential diagnosis in the presence of risk factors including immunosuppressive therapy, and a travel history should be carefully obtained. Patients with recurrent enterobacterial sepsis or respiratory failure with diffuse infiltrates in the setting of eosinophilia should undergo testing for  Strongyloides . A multidisciplinary approach can result in earlier diagnosis and favorable outcomes.

Immunosuppression with Antitumour Necrosis Factor Therapy Leading to Strongyloides Hyperinfection Syndrome