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Chest Infections |

Infestation in Ohio: A Case of Pulmonary Eosinophilia Secondary to Strongyloides

Christopher Kempe; James Allen; Subha Ghosh
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Ohio State University Wexner Medical Center, Columbus, OH


Chest. 2014;146(4_MeetingAbstracts):140A. doi:10.1378/chest.1959985
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Abstract

SESSION TITLE: Infectious Disease Cases I

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Sunday, October 26, 2014 at 10:45 AM - 12:00 PM

INTRODUCTION: Pulmonary eosinophilia secondary to parasites is relatively uncommon in the US. However, we present a case of pulmonary Strongyloidiasis in Ohio.

CASE PRESENTATION: A 52 year old male presented with one month of productive cough, fevers, chills and a fourteen pound weight loss. Chest imaging was performed, which showed bilateral cavitary lesions. His BAL contained 30% eosinophils. A Histoplasma serum antibody was positive. ANCA, ANA, HIV and a fungal immunodiffusion panel were negative. He had late growth (<10k CFU) of Klebsiella pneumoniae in his BAL culture. He was treated with Augmentin, but his symptoms persisted. His BAL fungal culture grew Histoplasmosis, for which he was treated with itraconazole. His symptoms continued despite therapy, so he was started on prednisone for possible acute eosinophilic pneumonia. He worsened clinically and was admitted. A Strongyloides antibody came back positive and his symptoms resolved with ivermectin within 24 hours. He was discharged home to complete 7 days of treatment. We present a case of pulmonary eosinophilia secondary to Strongyloides stercoralis with co-infection with Histoplasmosis in Ohio.

DISCUSSION: Pulmonary eosinophilia has a broad differential, with parasites being less common in the US. Our patient had Histoplasmosis, but this does not cause eosinophilia, which implied a concurrent second process driving his eosinophilia. For fungi, only Cocidioides and Aspergillus cause eosinophilia. Parasites such as Ascaris and Strongyloides are common causes of eosinophilia world-wide. The highest incidence of Strongyloides in the US is the Appalachian region, especially Kentucky and Tennessee (incidence of 2-4%). Typically patients present with fever, productive cough and dyspnea. Rarely Strongyloidiasis can cause cavitary lesions and pleural effusions. Complications including infections with gram negative bacteria that migrate with the parasite are common, and likely explain the finding of Klebsiella in our patient’s BAL.

CONCLUSIONS: This is a case of pulmonary eosinophilia secondary to Strongyloides causing cavitary lesions, with coinfection with Histoplasmosis. Parasitic infections should be considered in the differential for pulmonary eosinophilia even the US.

Reference #1: Akuthota P, Weller PF. Eosinophilic pneumonias. Clin Microbiol Rev. 2012;25(4):649-660.

Reference #2: Genta RM. Global prevalence of strongyloidiasis Rev Infect Dis. 1989;11(5):755-767.

Reference #3: Segarra-Newnham M. Strongyloides stercoralis infection. Ann Pharmacother. 2007;41(12):1992-2001.

DISCLOSURE: The following authors have nothing to disclose: Christopher Kempe, James Allen, Subha Ghosh

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