title: Strongyloidiasis and diffuse alveolar hemorrhage in a patient with systemic lupus erythematosus.
abstract: The presence of Strongyloides stercoralis infection in patients with systemic lupus erythematosus (SLE) has been described previously. Strongyloides stercoralis hyperinfection syndrome (SHS) that usually develops in patients under immunosuppressive therapy may affect a variety of organs, but the presentation with diffuse alveolar hemorrhage (DAH) is rare with only a few cases described in the literature. We present the case of a 36-year-old Hispanic female with a past medical history relevant for SLE and a recent diagnosis of lupus nephritis and hypertension. The patient who developed sudden and progressive abdominal pain and respiratory distress, with the presence of bilateral crackles and severe hypoxemia, is currently under treatment with steroids and cyclophosphamide for worsening of lupus nephritis. The patient underwent endotracheal intubation and mechanical ventilation, and computed tomography showed the presence of bilateral pulmonary infiltrates suggestive of DAH. Bronchoalveolar lavage was done and showed the presence of filariform larvae, morphologically consistent with Strongyloides stercoralis. Treatment with ivermectin was started and patient responded to treatment with improvement of clinical status. In conclusion, the development of SHS in patients with lupus, especially when receiving immunosuppressive therapy, is a severe and potentially fatal complication. Early detection and treatment may decrease mortality.
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gonzalez-Ibarra
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Parag
authors.initials: P
authors.lastname: Chevli
authors.affiliation: Department of Internal Medicine, St. George's University School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Schachter
authors.affiliation: Department of Internal Medicine, St. George's University School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Maninder
authors.initials: M
authors.lastname: Kaur
authors.affiliation: Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Sahar
authors.initials: S
authors.lastname: Eivaz-Mohammadi
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL 33331, USA.
authors.forename: Basheer
authors.initials: B
authors.lastname: Tashtoush
authors.affiliation: Department of Pulmonary and Critical care, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Jioty
authors.initials: J
authors.lastname: Matta
authors.affiliation: Laureate National Institute of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Amer K
authors.initials: AK
authors.lastname: Syed
authors.affiliation: Department of Rheumatology, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA.
authors.forename: Valentin
authors.initials: V
authors.lastname: Marian