Ann Geriatr Med Res.  2018 Dec;22(4):200-203. 10.4235/agmr.18.0041.

Acute Respiratory Distress Syndrome With Alveolar Hemorrhage due to Strongyloidiasis Hyperinfection in an Older Patient

• Kim EJ

• KMID: 2439117
• DOI: http://doi.org/10.4235/agmr.18.0041

Abstract

Strongyloides stercoralis is an intestinal nematode that occurs sporadically in temperate areas like Korea. People who are in the immunosuppressed state, over the age of 65 or under the corticosteroid therapy are at risk for developing Strongyloides hyperinfection syndrome. Acute respiratory distress syndrome (ARDS) with alveolar hemorrhage is a rare presentation of Strongyloides hyperinfection. A 78-year-old man had been irregularly injected corticosteroid on his knees, but did not have any immunosuppressive disease. He was initially diagnosed with ARDS and septic shock. Bronchoalveolar lavage (BAL) fluid was bloody and its cytology revealed helminthic larvae identified as S. stercoralis. Results of Cytomegalovirus polymerase chain reaction (PCR), Pneumocystis jirovecii PCR, and Aspergillus antigen testing of the BAL fluid were positive. The clinical progress quickly deteriorated with multiple organ failure, shock and arrhythmia, so he finally died. This is a rare case of ARDS in an older patient without any known immunosuppressive conditions, with alveolar hemorrhage and S. stercoralis being found via BAL.

Keyword

Strongyloides stercoralis; Acute respiratory distress syndrome; Alveolar hemorrhage

MeSH Terms

Aged
Arrhythmias, Cardiac
Aspergillus
Bronchoalveolar Lavage
Cytomegalovirus
Helminths
Hemorrhage*
Humans
Knee
Korea
Larva
Multiple Organ Failure
Pneumocystis jirovecii
Polymerase Chain Reaction
Respiratory Distress Syndrome, Adult*
Shock
Shock, Septic
Strongyloides
Strongyloides stercoralis
Strongyloidiasis*