Respiratory hyperinfection with Strongyloides stercoralis in a patient with renal failure.
BACKGROUND
A 40-year-old female presented to hospital with rapidly progressive renal failure secondary to antineutrophil cytoplasmic antibody (ANCA)-positive crescentic glomerulonephritis. She was started on immunosuppressive therapy (oral steroids and oral cyclophosphamide) and hemodialysis. She re-presented with persistent fever, persistent vomiting and dry cough 135 days after starting immunosuppression. A chest X-ray revealed left lower zone consolidation. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever did not respond to empirical antibiotics or antitubercular therapy. Bronchoscopic alveolar lavage and stool examination revealed larval forms of Strongyloides stercoralis.


METHODS
Physical examination, urine and blood analyses, chest X-ray, bronchoscopy and bronchoalveolar lavage examination.


METHODS
Respiratory hyperinfection syndrome due to S. stercoralis.


RESULTS
Ivermectin, albendazole and empirical broad-spectrum antibiotics for bacterial superinfection (amoxicillin and clavulanic acid for 5 days followed by piperacillin and tazobactam plus levofloxacin).
Rajapurkar
Mohan
M
Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. mmr@icenet.net
Hegde
Umapati
U
Rokhade
Mahesh
M
Gang
Sishir
S
Gohel
Kalpesh
K
D000284:Administration, Oral; D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D000977:Antiparasitic Agents / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007559:Ivermectin / Q000627:therapeutic use; D011014:Pneumonia / Q000469:parasitology; D013902:Radiography, Thoracic; D051437:Renal Insufficiency / Q000150:complications* / Q000209:etiology; D012141:Respiratory Tract Infections / Q000150:complications* / Q000000981:diagnostic imaging; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017171:Strongyloides stercoralis / Q000302:isolation & purification; D013322:Strongyloidiasis / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis
D000871:Anthelmintics; D019268:Antibodies, Antineutrophil Cytoplasmic; D000977:Antiparasitic Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D007559:Ivermectin; D003520:Cyclophosphamide; D015766:Albendazole