Combination therapy for disseminated strongyloidiasis with associated vancomycin-resistant, linezolid-intermediate Enterococcus faecium meningitis: A case report

What is known and objective: The rhabditid nematode Strongyloides stercoralis is the major causative agent of disseminated strongyloidiasis (DS). In rare cases, DS has caused enterococcal meningitis. If DS-associated vancomycin-resistant Enterococcus faecium (VRE) meningitis is suspected, combination antibiotic therapy should be considered. Case Summary: We present a case of a 61-year-old male who developed DS associated with vancomycin-resistant and linezolid-intermediate E. faecium meningitis after receiving corticosteroids. The VRE meningitis was treated with high-dose daptomycin 12 mg/kg, linezolid, tigecycline and quinupristin/dalfopristin. Despite negative cultures, the patient expired. What is new and conclusion: In patients with DS-associated VRE meningitis, early use of combination therapy may be warranted to improve patient outcomes.