Abstract
An 80-year-old female patient, who had been receiving maintenance hemodialysis for eight years for end-stage kidney disease due to diabetic nephropathy, presented to the ER with difficulty in walking after a fall. Severe trauma was not observed, but she presented with signs of inflammation and persistent mildly disturbed consciousness. Therefore, she was referred to our department for further evaluation. Collagen disease and malignancy were ruled out. On reviewing her detailed history, she was found to have had persistent eosinophilia, at least since the commencement of dialysis, and allergic reactions to drugs or dialysis equipment had been suspected. However, despite changing to erythropoiesis-stimulating agents and dialysis membranes, the eosinophilia did not improve, and she was administered steroids (maximum 5 mg of prednisone) to address a tentative diagnosis of idiopathic eosinophilia. Since eosinophilia persisted until the present admission, thorough evaluation was carried out to explain the eosinophilia, including tests for parasitic diseases as a differential diagnosis. Strongyloides was detected in a stool sample and a final diagnosis of strongyloidiasis was made, although findings of organ damage, including lung or gastrointestinal tract damage, were not detected, and the patient had no history of travel to strongyloidiasis endemic areas. When unexplained eosinophilia is detected in dialysis patients, parasitic diseases should be excluded, including those not endemic to the area in which the patient resides.
