Strongyloides stercoralis infection after the use of emergency corticosteroids: a case report on hyperinfection syndrome

Abstract

Background In clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids. However, not all that wheezes is asthma. Case presentation A 61-year-old man from the Peruvian Amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. His medical history was remarkable for asthma since childhood; he was treated with beta-agonists, ipratropium, and orally administered corticosteroids. On evaluation, he was febrile and ill-appearing. His chest examination revealed diffuse wheezing and bilateral crackles. He was diagnosed as having community-acquired pneumonia and asthma exacerbation and was started on empiric antibiotics, nebulized beta-agonists, and orally administered corticosteroids. His clinical status continued deteriorating and he became critically ill despite broad-spectrum antibiotics and antifungals. Considering the epidemiological background of our patient, bronchoalveolar and fecal samples were obtained to investigate soil-transmitted helminths. Larvae of Strongyloides stercoralis were found in both specimens. Ivermectin was initiated and corticosteroids were discontinued. He experienced remarkable improvement of clinical condition over the next weeks. The literature on this topic was reviewed. Conclusion Cases of severe asthma exacerbation warrant careful evaluation before the initiation of corticosteroids, especially in patients at risk for parasitic infections. A high index of suspicion is critical. Alternative etiologies of respiratory decompensation should be considered in patients who fail to improve with broad-spectrum antibiotics and antifungals.

Parasitic necrotizing pneumonia in an immunocompetent patient in United States

“…The diagnosis is usually made by demonstration of rhabditiform larvae in stool, sputum, or duodenal aspirates. Antibody assays are shown to have sensitivities of approximately 90%; however, cross-reactions can cause antibody levels to also be low in immunocompromised patients [7]. Fortunately, in this case, the diagnosis could quickly and easily be made by the analysis of the sputum stain.…”

“…Strongyloidiasis is generally a benign parasitic infection, more common in tropical and subtropical countries [6]. There have been cases of strongyloides pneumonia seen in immunocompromised patients, like HTLV-I, HIV, malignancy, congenital immunodeficiency or those on long-term corticosteroids or other immunosuppressive agents [7,8]. Although the exact dose of corticosteroids is not known, doses as low as 20 mg daily for 5 weeks have been shown to be sufficient to cause immunosuppression causing strongyloides necrotizing pneumonia [9].…”

Strongyloides stercoralis colitis in a patient positive for human T-cell leukaemia virus with rheumatoid arthritis during an anti-rheumatic therapy: a case report

“…Biologics, corticosteroids and HTLV-1 infection have been identified as risk factors for strongyloidiasis [1,5,15]. It was difficult to distinguish between Strongyloides colitis and UC on endoscopy prior to treatment with GLM and an intermediate dose of corticosteroid.…”

Strongyloides Hyperinfection Syndrome: A Curious Case of Asthma Worsened by Systemic Corticosteroids

“…This species has a worldwide distribution and is found mostly in rural regions of tropical and subtropical countries. In the United States, some southeastern states are endemic areas; however, sporadic cases are reported throughout the United States, with patients mostly being immigrants, travelers, and military personnel with a travel history to endemic regions of the world [ 2 , 6 , 7 ].…”

“…The estimated prevalence is reported to be 100 million worldwide [ 1 ]. Although strongyloidiasis primarily occurs in underdeveloped countries, its incidence has increased in nonendemic areas of the United States due to immigration [ 2 ]. Presentation of S. stercoralis infection varies from asymptomatic to symptomatic with multisystem involvement.…”