chronic infections with s. stercoralis can be clinically unapparent or can lead to cutaneous , gastrointestinal or pulmonary symptoms . we report the first case of capd - related peritonitis as an unusual presentation of s. stercoralis infection . a 67-year - old male patient who had been on capd therapy for end - stage renal disease secondary to type 2 diabetes mellitus . he experienced two episodes of capd peritonitis secondary to enterococcus spp and metycilline - sensitive staphylococcus aureus in december 2007 and june 2008 , respectively . the patient presented to our hospital due to abdominal pain , tenderness , cloudy effluent and pruritus . the remaining physical examination was normal . on admission , haemogram showed white blood cell count 10.700/mm with 76% neutrophils and 6% eosinophils and haemoglobin 11.6 g / dl . blood urea nitrogen was 72 mg / dl , and serum creatinine was 6.6 mg / dl . s. stercoralis larvae were seen on centrifuged dialysate sediment with microscopic examination ( figure 1 ) . the patients ' complaints disappeared and dialysate white blood cell count decreased to 100/mm 4 days later without a need for catheter removal . we did not detect larvae in three stool samples and treatment finished at the end of the first month . some rhabdoid larvae may transform back into filariform larvae and penetrate either the colonic mucosa ( internal autoinfection ) or the perianal skin ( external autoinfection ) , allowing the internal life cycle leading to small intestinal infection to continue . transient and pruritic dermatitis is caused by the intradermal migration of the larvae in the skin . the other symptoms are abdominal pain , diarrhoea , cough and anorexia [ 68 ] . strongyloides infections can be detected by the examination of host faeces for strongyloides larvae or by the examination of the small intestine of a host for parasitic females . elisa tests for detecting serum igg against antigens of s. stercoralis may also use for strongyloidosis . response to anthelmintic therapy was defined as the disappearance of parasites in three stool samples performed at least 6 weeks after therapy . in our patient , strongyloides peritonitis may have occurred due to transmigration of parasite across the bowel wall . alternatively , the entrance of parasite into the peritoneal cavity is also possible via touch contamination of the catheter during an exchange . our findings suggest that s. stercoralis may cause the development of capd peritonitis and pruritus might be the sign of this infection .
a 67-year - old male continuous ambulatory peritoneal dialysis ( capd ) patient presented with abdominal pain and pruritus . 
 strongyloides stercoralis larvae were seen on dialysate sediment and stool microscopic examination . 
 albendazole was given and improved the symptoms in 4 days . 
 there was no episode of relapsing peritonitis after the therapy . 
 this is the first report of s. stercoralis peritonitis in patients on capd . 
 strongyloides should be considered as a probable peritoneal pathogen in capd patients .