Background: Strongyloides stercoralis is a common intestinal nematode that affects 30–100 million people worldwide. It is endemic in Guilan province and especially affects the rural population.
Case Report: 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 led to an acceptable outcome.
Conclusions: All patients who are candidates for immunosuppressive therapy or who are planned to receive steroid should be evaluated for strongyloidiasis. Although a stool exam is the first and simplest test for this purpose, it may be negative for the parasite despite a large parasitic burden. Thus physician awareness should be emphasized and a high index of suspicion required to diagnose this ominous condition by further evaluation (serology, evaluation of duodenal aspirate, and endoscopy with biopsy).

Keywords: Strongyloidea, sepsis, immunosuppresion