Delayed Strongyloides stercoralis hyperinfection syndrome in a renal transplant patient with Pneumocystis jirovecii pneumonia receiving high-dose corticosteroids

A 50-year old man who had not travelled outside the UK for the past 20 years—but who had lived in Angola for most of his childhood—presented at our clinic with a 4-week history of worsening exercise tolerance. The patient had undergone renal transplantation 2 years and 6 years previously. Since transplantation, his estimated glomerular filtration rate had been slowly decreasing, most likely due to chronic graft rejection, and he was therefore on high-dose immunosuppression treatment with tacrolimus 8 mg twice daily, mycophenolate mofetil 500 mg twice daily, and prednisolone 5 mg once daily. On physical examination, he was afebrile but had a respiratory rate of 30 breaths per min.