SESSION TITLE: Infectious Disease Student/Resident Case Report Posters II
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM
INTRODUCTION: Systemic Lupus Erythematosus (SLE) is an autoimmune disease that causes potentially life-threatening flares, affecting all systems of the body. Treatment, particularly for flare-ups, includes corticosteroids, which causes an immunocompromised state, placing individuals at further increased risk for bacterial, fungal and parasitic infections. One such infection is that of Strongyloides stercoralis, which can lead to a hyperinfection syndrome (HS). Patients infected with Strongyloides may be at increased risk for the severe but rare complication of diffuse alveolar hemorrhage (DAH) which has been associated with 70-90% mortality.
CASE PRESENTATION: We present a 36 year old female with a past medical history SLE and lupus nephritis, admitted to the hospital due worsening of her lupus nephritis. The patient was treated with cyclophosphamide along with multiple pulsed doses of steroids and during hospital course patient experienced progressive hypoxemic respiratory failure. Computed tomography (CT) of the thorax showed diffuse airspace opacities. Bronchoalveolar lavage (BAL) was performed and showed filariform larvae, morphologically consistent with strongyloides stercoralis. The patient was treated with Ivermectin with a favorable response. CT thorax at four months of follow-up demostrated improvement in airspace opacities.
DISCUSSION: Strongyloides stercoralis is a parasite endemic to tropical and subtropical regions. The parasite invades the intact skin of its host, traveling via the lymphatic system to the venous system, which carries the parasite to the lungs, where it is able to penetrate through the alveolar spaces. In the immunocompromised population may lead to immense proliferation of the parasite, causing what is known as HS and may eventually develop DAH. Early detection and treatment may decrease mortality.
CONCLUSIONS: It is essential to investigate for the presence of Strongyloides Stercoralis in these immunocompromised individuals, even in non-endemic areas.
Reference #1: Mohanasundaram K, et al. Successful treatment of Strongyloides stercoralis hyperinfection in a case of systemic lupus erythematosus - review of the literature regarding various treatment schedules. Trop Doct 2012; 42:223-225.
Reference #2: Quadrelli SA, et al. Pulmonary involvement of systemic lupus erythematosus: analysis of 90 necropsies. Lupus 2009; 18:1053-1060.
DISCLOSURE: The following authors have nothing to disclose: Parag Chevli, Fernando Gonzalez-Ibarra, Jyoti Matta, Lindsey Schachter, Maninder Kaur, Amer Syed, Basheer Tashtoush, Sahar Eivaz-Mohammadi
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