Hemoptysis in the immunocompromised patient: Do not forget strongyloidiasis

Prakash Shrestha, Sean E. O'Neil, Barbara Taylor, Olaoluwa Bode-Omoleye, Gregory M Anstead

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis.

Original languageEnglish (US)
Article number35
JournalTropical Medicine and Infectious Disease
Volume4
Issue number1
DOIs
StatePublished - Feb 12 2019

Keywords

  • Albendazole
  • Corticosteroids
  • Eosinophilia
  • Hemoptysis
  • Ivermectin
  • Strongyloides stercoralis
  • Strongyloidiasis

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • Immunology and Microbiology(all)

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