Recurrent Klebsiella bacteremia due to chronic strongyloidiasis in the context of cirrhotic hepatopulmonary syndrome

A woman in her 50s with a medical history of cirrhosis, alcohol use disorder, primary biliary cholangitis and extended spectrum beta lactamase (ESBL) Klebsiella presented with weakness, cough and abdominal pain with positive blood cultures for ESBL Klebsiella, and was treated with intravenous meropenem and patient symptoms improved. Testing for Strongyloides antibodies was positive, so she was treated with ivermectin. Strongyloidiasis-associated Gram-negative rod (GNR) bacteremia are rare conditions; however, it is important to consider an underlying strongyloidiasis in recurrent GNR bacteremia to prevent recurrent hospitalisation and morbidity.