Tuberc Respir Dis.  2010 Jan;68(1):29-33.

A Case of Fatal Hyperinfective Strongyloidiasis with Acute Respiratory Failure and Intestinal Perforation in Lung Cancer Patient

• Kim HS
• Kim YE
• Yun EY
• Ju JH
• Ma JE
• Lee GD
• Cho YJ
• Kim HC
• Lee JD
• Hwang YS
• Jeong YY

Abstract

Strongyloides stercoralis is an intestinal nematode that is a parasite to humans. The infecting filariform larvae of S. stercoralis enters the host body via the bloodstream, passes through the lungs, penetrates the alveoli, and then ascends the airway to transit down the esophagus into the small bowel. The infection can persist for decades without causing major symptoms and can elicit eosinophilia of varying magnitudes. Of note, this infection can also develop into a disseminated, often fatal, disease (hyperinfection) in patients receiving immunosuppressive corticosteroids. A 65-year-old man who was receiving corticosteroid therapy for the treatment of spinal stenosis was admitted to the emergency room with complaints of abdominal pain and severe dyspnea. We detected many S. stercoralis larvae in the sputum and in the bronchoalveolar-lavage sample collected by bronchoscopy. Here, we report a fatal case of strongyloidiasis with acute respiratory failure and intestinal perforation. In addition, we provide a brief review of the relevant medical literature.

Keyword

Strongyloides stercoralis; Respiratory Insufficiency; Intestinal Perforation; Immunosuppression

MeSH Terms

Abdominal Pain
Adrenal Cortex Hormones
Aged
Bronchoscopy
Dyspnea
Emergencies
Eosinophilia
Esophagus
Humans
Immunosuppression
Intestinal Perforation
Larva
Lung
Lung Neoplasms
Parasites
Respiratory Insufficiency
Spinal Stenosis
Sputum
Strongyloides stercoralis
Strongyloidiasis
Adrenal Cortex Hormones

Figure

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  Figure 1 Chest PA shows numerous ill-defined tiny nodules and diffuse, bilateral ground-glass opacities in both lung fields.

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  Figure 2 Chest HRCT (A), Chest CT (B) reveals diffuse, bilateral ground-glass opacities in both lung fields and 3.2 cm sized, spiculated mass in the right upper lung zones.

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  Figure 3 The third stage filariform larvae of Strongyloides stercoralis in sputums has typically a notched tail (arrow) (Papanicolaou, ×100).

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  Figure 4 The third stage filariform larvae of Strongyloides stercoralis obtained through bronchoalveolar lavage (Papanicolaou, ×100).

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