Abstract
Strongyloides stercoralis can complete its entire life cycle within the human host, allowing infections to persist for years. While it may cause chronic, often asymptomatic infection in immunocompetent individuals, it can lead to life-threatening hyperinfection syndrome or disseminated disease in those who are immunocompromised. We report a case of Strongyloides hyperinfection syndrome in a heart transplant recipient who had tested negative on conventional serologic screening as part of his pretransplant workup three years prior to transplantation. The patient developed severe disease characterized by ileus and respiratory failure, and was treated with a combination of oral, rectal, and veterinary-formulated subcutaneous ivermectin. The patient demonstrated a favorable response and achieved full recovery. This case contributes to the growing literature supporting the use of subcutaneous ivermectin as a viable treatment option in patients with compromised gastrointestinal absorption.