Nguyen H. Thanh ¹ Mai T. Hoai ² Quy Khoa ¹ Vo T. Mai ¹ Dinh T. Nga ^2* Pham M. Quang ² Nguyen C. Binh ^2* Duong T. Tuyet ^2* Nguyen L. Tung ^2* Thai D. Ky ^2*

• ¹ College of Health Sciences, Vin University, Hanoi, Vietnam
• ² Department of Gastroenterology, 108 Hospital, Hanoi, Vietnam

Cytomegalovirus (CMV) infection is an opportunistic disease in immunocompromised patients that may appear without symptoms, with constitutional symptoms, or as a tissue-invasive disease. Strongyloides stercoralis infection often manifests with nonspecific symptoms; however, it can lead to severe malabsorption and extraintestinal dissemination by accelerated autoinfection. The coinfection of CMV and Strongyloides stercoralis 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. Strongyloides stercoralis was detected by the duodenal biopsy results, and the PCR of these samples was positive with CMV. The patient underwent upper endoscopy four times to control the bleeding and received treatment with ivermectin and ganciclovir. The patient improved gradually and was discharged after 4 weeks of hospitalization. The coinfection of CMV and Strongyloides stercoralis causing massive GI bleeding has been rarely reported. To 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 Strongyloides stercoralis in patients with immunosuppression, other risk factors, or unexplained gastrointestinal symptoms.