title: Survival in a case of diffuse alveolar hemorrhage due to Strongyloides stercoralis hyperinfection.
abstract: Strongyloides stercoralis is an intestinal nematode endemic to tropical and sub-tropical regions. Although infection is typically asymptomatic or self-limited, immunocompromised individuals can develop a severe form of disease marked by hyperinfection. Pulmonary involvement accompanies hyperinfection in a majority of cases, though manifestations range from asymptomatic infiltrates to diffuse alveolar hemorrhage (DAH) and respiratory failure. When complicated by DAH, the hyperinfection syndrome is usually fatal. We report a case of a 65-year-old Guatemalan woman with chronic inflammatory demyelinating polyneuropathy (CIDP) treated with chronic steroids who presented with Escherichia coli urosepsis. She was initially treated with antibiotics and corticosteroids. She subsequently developed DAH due to disseminated strongyloidiasis. She was treated with oral and subcutaneous ivermectin and had complete recovery.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, United States.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Steinhaus
authors.affiliation: Department of Medicine, Massachusetts General Hospital, United States.
authors.forename: Justin F
authors.initials: JF
authors.lastname: Gainor
authors.affiliation: Department of Medicine, Newton Wellesley Hospital, United States ; Division of Pulmonary Medicine, Newton Wellesley Hospital, United States.
authors.forename: Inna
authors.initials: I
authors.lastname: Vernovsky
authors.affiliation: Department of Medicine, Newton Wellesley Hospital, United States ; Division of Infectious Disease, Newton Wellesley Hospital, United States.
authors.forename: Julie
authors.initials: J
authors.lastname: Winsett
authors.affiliation: Department of Medicine, Newton Wellesley Hospital, United States ; Division of Pulmonary Medicine, Newton Wellesley Hospital, United States.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Beer
keywords: BAL, bronchoalveolar lavage; CIDP, chronic inflammatory demyelinating polyneuropathy; DAH, diffuse alveolar hemorrhage; Diffuse alveolar hemorrhage; Hyperinfection; ICU, intensive care unit; Pulmonary Strongyloides stercoralis; WBC, white blood cell