{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:01:22Z","timestamp":1753891282993,"version":"3.41.2"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T00:00:00Z","timestamp":1732060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Cytomegalovirus (CMV) infection is an opportunistic disease in immunocompromised patients that may appear without symptoms, with constitutional symptoms, or as a tissue-invasive disease. <jats:italic>Strongyloides stercoralis<\/jats:italic> infection often manifests with non-specific symptoms; however, it can lead to severe malabsorption and extraintestinal dissemination by accelerated autoinfection. The coinfection of CMV and <jats:italic>Strongyloides stercoralis<\/jats:italic> has rarely been reported, particularly with solely severe gastrointestinal bleeding. A 29-year-old female patient with a history of nephrotic syndrome treated with long-term corticosteroid and poorly controlled type 2 diabetes presented with a 20-day history of persistent epigastric pain, diarrhea, and significant weight loss. At the hospitalization, the patient appeared to have persistent gastrointestinal bleeding, leading to hypovolemic shock and diabetic ketoacidosis. <jats:italic>Strongyloides stercoralis<\/jats:italic> was detected by the duodenal biopsy results, and the polymerase chain reaction of these samples was positive for CMV. The patient underwent upper endoscopy four times to control the bleeding and was treated with ivermectin and ganciclovir. The patient improved gradually and was discharged after 23\u2009days of hospitalization. The coinfection of CMV and <jats:italic>Strongyloides stercoralis<\/jats:italic> causing massive gastrointestinal (GI) bleeding has been rarely reported. To the best of our knowledge, this is also the first case of coinfection of these pathogens in an immunocompromised patient complicated with hypovolemic shock caused by GI bleeding and diabetic ketoacidosis. Clinicians should have a high index of suspicion and test simultaneously CMV and <jats:italic>Strongyloides stercoralis<\/jats:italic> in patients with immunosuppression, other risk factors, or unexplained gastrointestinal symptoms.<\/jats:p>","DOI":"10.3389\/fmed.2024.1438689","type":"journal-article","created":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T14:09:12Z","timestamp":1732111752000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Coinfection of cytomegalovirus and strongyloidiasis presenting as massive gastrointestinal bleeding in an immunocompromised host: a case report"],"prefix":"10.3389","volume":"11","author":[{"given":"Thanh Nguyen","family":"Huu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoai Mai","family":"Thu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khoa","family":"Quy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mai Vo","family":"Thanh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nga Dinh","family":"Thi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quang Pham Minh","family":"Ngoc","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tuyet Duong","family":"Thi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Binh Nguyen","family":"Canh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tung Nguyen","family":"Lam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ky Thai","family":"Doan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,11,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1128\/microbiolspec.DMIH2-0022-2015","article-title":"Cytomegalovirus","volume":"4","author":"Dioverti","year":"2016","journal-title":"Microbiol Spectr"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"352","DOI":"10.3390\/v14020352","article-title":"Cytomegalovirus diseases of the gastrointestinal tract","volume":"14","author":"Yeh","year":"2022","journal-title":"Viruses"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1007\/s11894-012-0266-4","article-title":"Cytomegalovirus infection and the gastrointestinal tract","volume":"14","author":"You","year":"2012","journal-title":"Curr Gastroenterol Rep"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1016\/j.trstmh.2009.02.013","article-title":"Strongyloidiasis \u2013 the most neglected of the neglected tropical diseases?","volume":"103","author":"Olsen","year":"2009","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1128\/CMR.17.1.208-217.2004","article-title":"Strongyloides stercoralis in the immunocompromised population","volume":"17","author":"Keiser","year":"2004","journal-title":"Clin Microbiol Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"f4610","DOI":"10.1136\/bmj.f4610","article-title":"Strongyloides stercoralis infection","volume":"347","author":"Greaves","year":"2013","journal-title":"BMJ"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"135","DOI":"10.14309\/crj.0000000000000135","article-title":"Strongyloides stercoralis Hyperinfection and concomitant cytomegalovirus gastroenteritis in an immunocompromised host","volume":"6","author":"Crowe","year":"2019","journal-title":"ACG Case Rep J"},{"key":"ref8","first-page":"86","article-title":"Strongyloides hyperinfection syndrome and cytomegalovirus infection in a patient with type II diabetes mellitus","volume":"46","author":"Wang","year":"2023","journal-title":"New Microbiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"331","DOI":"10.3390\/tropicalmed8060331","article-title":"Strongyloides spp. and cytomegalovirus co-infection in patient affected by non-Hodgkin lymphoma","volume":"8","author":"Lupia","year":"2023","journal-title":"Trop Med Infect Dis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"559","DOI":"10.3904\/kjim.2015.30.5.559","article-title":"A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers","volume":"30","author":"Chung","year":"2015","journal-title":"Korean J Intern Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1097\/00004836-200006000-00016","article-title":"Ileal perforation caused by cytomegalovirus infection in a critically ill adult","volume":"30","author":"Chamberlain","year":"2000","journal-title":"J Clin Gastroenterol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.3109\/00365521.2011.594083","article-title":"Cytomegalovirus infection of the upper gastrointestinal tract: a clinical and pathological study of 30 cases","volume":"46","author":"Reggiani Bonetti","year":"2011","journal-title":"Scand J Gastroenterol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"301","DOI":"10.4253\/wjge.v8.i6.301","article-title":"Characteristic endoscopic findings and risk factors for cytomegalovirus-associated colitis in patients with active ulcerative colitis","volume":"8","author":"Hirayama","year":"2016","journal-title":"World J Gastrointest Endosc"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"3214","DOI":"10.1017\/S0950268817002333","article-title":"Strongyloides stercoralis seroprevalence in Vietnam","volume":"145","author":"Diep","year":"2017","journal-title":"Epidemiol Infect"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"581","DOI":"10.4321\/S1135-57272014000500004","article-title":"Diagnosis of Strongyloides Stercoralis infection: meta-analysis on evaluation of conventional parasitological methods (1980-2013)","volume":"88","author":"Campo Polanco","year":"2014","journal-title":"Rev Esp Salud Publica"},{"key":"ref16","first-page":"616","article-title":"Improved diagnosis of strongyloides stercoralis by seven consecutive stool specimens","volume":"263","author":"Nielsen","year":"1987","journal-title":"Zentralbl Bakteriol Mikrobiol Hyg A"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1097\/QCO.0b013e3283551dbd","article-title":"Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis","volume":"25","author":"Mejia","year":"2012","journal-title":"Curr Opin Infect Dis"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1768","DOI":"10.3748\/wjg.14.1768","article-title":"Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection","volume":"14","author":"Kishimoto","year":"2008","journal-title":"World J Gastroenterol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e15845","DOI":"10.1097\/MD.0000000000015845","article-title":"Can endoscopists differentiate cytomegalovirus esophagitis from herpes simplex virus esophagitis based on gross endoscopic findings?","volume":"98","author":"Jung","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/S0016-5107(82)72998-0","article-title":"Gastric candidiasis: an endoscopic and histological study in 26 patients","volume":"28","author":"Minoli","year":"1982","journal-title":"Gastrointest Endosc"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4103\/jde.jde_48_16","article-title":"Endoscopic features of gastrointestinal tuberculosis and crohn\u2019s disease","volume":"8","author":"Moka","year":"2017","journal-title":"J Dig Endosc"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"358","DOI":"10.3390\/tropicalmed8070358","article-title":"Overlapping infection by Strongyloides spp. and cytomegalovirus in the immunocompromised host: a comprehensive review of the literature. Trop med","volume":"8","author":"Lupia","year":"2023","journal-title":"Infect Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1080\/08998280.2021.1997262","article-title":"Strongyloides stercoralis and cytomegalovirus coinfection in a patient with a transplanted kidney","volume":"35","author":"Fallahzadeh","year":"","journal-title":"Proc (Bayl Univ Med Cent)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"CD007745","DOI":"10.1002\/14651858.CD007745.pub3","article-title":"Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection","volume":"2016","author":"Henriquez-Camacho","year":"2016","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1438689\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,20]],"date-time":"2024-11-20T14:09:15Z","timestamp":1732111755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1438689\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,20]]},"references-count":24,"alternative-id":["10.3389\/fmed.2024.1438689"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1438689","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2024,11,20]]},"article-number":"1438689"}}