Pulmonary Strongyloidiasis in a Patient Receiving Prednisolone Therapy

Abstract

Strongyloidiasis is widely distributed in tropical and subtropical areas. Disseminated strongyloidiasis may develop in patients with immunodeficiencies. In the absence of early diagnosis and treatment, the prognosis of disseminated strongyloidiasis is extremely poor. We report a case of pulmonary strongyloidiasis that was successfully treated. The patient was an 83-year-old woman who had been receiving long-term oral prednisolone therapy for uveitis. The patient visited our emergency department complaining of breathing difficulties and diarrhea. A chest X-ray revealed a diffuse enhancement of interstitial shadows. A bronchoalveolar lavage (BAL) was performed, and both Gram staining and Grocott's staining revealed the presence of multiple filariform larvae of Strongyloides stercoralis in the bronchoalveolar lavage fluid (BALF). A stool examination performed at the same time also yielded S. stercoralis. The patient was diagnosed as having pulmonary strongyloidiasis and was treated with thiabendazole and ivermectin, in addition to antimicrobial agents; her respiratory symptoms and diarrhea improved, and S. stercoralis was not detected in subsequent follow-up examinations thereafter. In endemic areas of S. stercoralis, pulmonary strongyloidiasis should be considered as part of a differential diagnosis if chest imaging findings like alveolar and interstitial shadow patterns or lobar pneumonia are seen in patients with immunodeficiencies. (Internal Medicine 43: 731-736, 2004)

Fatal Strongyloides stercoralis hyper-infection in a patient with multiple myeloma

“…5 Most of the cases (70%) occur in men, with a median age of 51 years. 6 The clinical manifestation vary: fever, chills may not always be present, but mal-absorption syndrome, paralytic ileus, ulcerative enteritis and bleeding can complicate the disease.…”

“…The chest x-ray most frequently shows bilateral focal interstitial infi ltrates. 5,11 Cutaneous symptoms are also frequent and include pruritus, urticarial serpiginous rash called larvae currens, which is pathognomonic of S.S infection. These lesions are usually located in the lower trunk and thighs.…”

“…However, it has been reported that all organs could be involved if the diagnosis is not made until later. 1,3,5,6 Hyper-infection is often complicated by bacterial and fungal infection, 1,3,6,11 because of the leakage of gut fl ora from a damaged bowel by moving larvae. Enteric bacteria are also carried by invasive larvae in their outer surfaces.…”

“…1,[3][4][5][6][7][8] Of these, the most commonly reported risk factor is immunosupression due to steroids use. Out of more than 50 cases of hyperinfection and disseminated infection have been reported since 2000, the use of steroids was noted in 64% of cases.…”

“…is extremely poor. 5 We present a case of a disseminated strongyloidiasis following the treatment of myeloma.…”