Image of the month: Target the bugs: Strongyloides stercoralis hyperinfection.

A 74-year-old woman carrying the human T-lymphotropic virus type-1 (HTLV-1) presented with abdominal pain and vomiting. Computed tomography and microscopic analysis of the gastroduodenal drainage fluid made a diagnosis of paralytic ileus due to Strongyloides stercoralis hyperinfection with underlying HTLV-1 infection. Strongyloidiasis should be included in the differential diagnosis for paralytic ileus in patients who have lived in or migrated from the endemic regions. © Royal College of Physicians 2021. All rights reserved.