ABSTRACT
Strongyloides stercoralis is a common intestinal nematode that affects 30-100 million people worldwide. It is endemic in Guilan province, northern Iran and especially strikes the rural population. We report the case of a 65-year-old woman living in Guilan province of Iran with a history of diabetes mellitus who was treated with high-dose prednisolone for temporal arteritis. Undiagnosed infestation by this nematode led to disseminated strongyloidiasis and Gram-negative sepsis. Fortunately, early diagnosis and prompt therapy with a proper anthelmintic drug as well as supportive care resulted in an acceptable outcome. All the patients who are candidates for immunosuppressive therapy or planned to receive steroid should be evaluated for strongyloidiasis. Although a stool test is the first and simplest test for this purpose, it may be negative for the parasite despite a large parasitic burden. Thus, physician's awareness should be emphasized and a high index of suspicion required to diagnose this ominous condition by further evaluation [serology, evaluation of duodenal aspirate, endoscopy with biopsy and stool exam with proper culture by an expert, at index laboratories].