Strongyloides stercoralis disseminated infection in a patient misdiagnosed with chronic asthmatic bronchitis

Strongyloides stercoralis is a soil-transmitted intestinal nematode, commonly causing pulmonary infection, abdominal pain, or diarrhea. If immune systems are compromised, the nematode larvae may spread and develop a potentially fatal auto-infection syndrome in the host. We present a case of a farmer with disseminated strongyloidiasis, whose past medical history included repeated cough and expectoration associated with wheezing for 30 years. He was originally misdiagnosed with chronic asthmatic bronchitis and received intravenous methylprednisolone 40e80 mg/day during an asthmatic episode. The patient’s laboratory data (Table 1) notably revealed a high eosinophil count of 9.4%, a possible indication of a parasitic infection. Blood gas analysis indicated severe hypoxemia with PaO2/FiO2 < 150 mmHg (PaO2 Z 44 mmHg and FiO2 Z 40%). His initial chest radiograph showed diffuse pulmonary infiltrates (Fig. 1A). A potentially significant finding, interlobular septal thickening,was revealedbya high resolution chest computedtomography (CT) scan (Fig. 1B).Contrast-enhanced CT scan of the abdomen only revealed bowel wall thickening (Fig. 1C). However, a subsequent esophagogastroduodenoscopy showed multiple small white miliary nodules in duodenal submucosal tissue (Fig. 1D); duodenal biopsy specimens further found the ova and the insect body of S. stercoralis (Fig. 1E). While an encephalopathy developed, a head MRI scanshowedablurred slightlyhyperintensenodular lesion in the right temporal lobe near themeninges (Fig. 1F, G). As in the case of Feely et al, central nervous system damage caused by nematodes migration should be considered. Additionally, stool and sputum parasitological examinations were all positive for S. stercoralis larvae, so the diagnosis of S. stercoralis disseminated infection was declared. Within 24 hours after the diagnosis, treatment with albendazole was started up to 2 weeks. On the 3 day after