title: An unusual cause of pulmonary haemorrhage in a patient with rheumatoid arthritis.
abstract: BACKGROUND
  Pulmonary haemorrhage is a rare presentation of strongyloides hyperinfection.
  
  
  METHODS
  A 69-year-old female patient with rheumatoid arthritis on methotrexate and prednisolone presented with severe community acquired pneumonia. Intravenous trimethoprim/ sulfamethoxazole (bactrim) and high dose hydrocortisone for Pneumocystis carinii pneumonia were commenced. She developed pulmonary haemorrhage 2 weeks later and bronchoalveolar lavage cytology revealed helminthic larvae identified as strongyloides.
  
  
  RESULTS
  Despite treatment with ivermectin and albendazole with rapid tailing down of hydrocortisone, she succumbed to her illness.
  
  
  CONCLUSIONS
  Strongyloides hyperinfection should be considered in an immunocompromised patient on high dose corticosteroid presenting with pulmonary haemorrhage. Prognosis remains dismal as supported by our case report and current literature.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore. gm3ksy@sgh.com.sg
authors.forename: M S
authors.initials: MS
authors.lastname: Koh
authors.forename: P H
authors.initials: PH
authors.lastname: Leng
authors.forename: P
authors.initials: P
authors.lastname: Eng
authors.forename: J
authors.initials: J
authors.lastname: Hwang
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008171:Lung Diseases / Q000209:etiology*; D008174:Lung Diseases, Parasitic / Q000150:complications*; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000188:drug therapy; D011859:Radiography; D013322:Strongyloidiasis / Q000150:complications* / Q000000981:diagnostic imaging; D015163:Superinfection / Q000150:complications*
chemical_list: D007166:Immunosuppressive Agents