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Open AccessCase Report

Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasis

1
Covenant Medical Group, Infectious Diseases, Division of Internal Medicine, Lubbock, TX 79410, USA
2
Texas Center for Infectious Diseases, San Antonio, TX 78223, USA
3
Department of Medicine, Division of Infectious Diseases, University of Texas Health, San Antonio, TX 78229, USA
4
Department of Pathology, University of Texas Health, San Antonio, TX 78229, USA
5
Medicine Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, TX 78229, USA
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Trop. Med. Infect. Dis. 2019, 4(1), 35; https://doi.org/10.3390/tropicalmed4010035
Received: 31 December 2018 / Revised: 26 January 2019 / Accepted: 29 January 2019 / Published: 12 February 2019
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Abstract

Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis. View Full-Text
Keywords: strongyloidiasis; Strongyloides stercoralis; hemoptysis; eosinophilia; ivermectin; albendazole; corticosteroids strongyloidiasis; Strongyloides stercoralis; hemoptysis; eosinophilia; ivermectin; albendazole; corticosteroids
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MDPI and ACS Style

Shrestha, P.; O’Neil, S.E.; Taylor, B.S.; Bode-Omoleye, O.; Anstead, G.M. Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasis. Trop. Med. Infect. Dis. 2019, 4, 35.

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