Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus
The presence of Strongyloides stercoralis infection in patients with systemic lupus erythematosus (SLE) has been described previously. Strongyloides stercoralis hyperinfection syndrome (SHS) that usually develops in patients under immunosuppressive therapy may affect a variety of organs, but the pre...
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| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2014/278390 |
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| author | Fernando Gonzalez-Ibarra Parag Chevli Lindsey Schachter Maninder Kaur Sahar Eivaz-Mohammadi Basheer Tashtoush Jioty Matta Amer K. Syed Valentin Marian |
| author_facet | Fernando Gonzalez-Ibarra Parag Chevli Lindsey Schachter Maninder Kaur Sahar Eivaz-Mohammadi Basheer Tashtoush Jioty Matta Amer K. Syed Valentin Marian |
| author_sort | Fernando Gonzalez-Ibarra |
| collection | DOAJ |
| description | The presence of Strongyloides stercoralis infection in patients with systemic lupus erythematosus (SLE) has been described previously. Strongyloides stercoralis hyperinfection syndrome (SHS) that usually develops in patients under immunosuppressive therapy may affect a variety of organs, but the presentation with diffuse alveolar hemorrhage (DAH) is rare with only a few cases described in the literature. We present the case of a 36-year-old Hispanic female with a past medical history relevant for SLE and a recent diagnosis of lupus nephritis and hypertension. The patient who developed sudden and progressive abdominal pain and respiratory distress, with the presence of bilateral crackles and severe hypoxemia, is currently under treatment with steroids and cyclophosphamide for worsening of lupus nephritis. The patient underwent endotracheal intubation and mechanical ventilation, and computed tomography showed the presence of bilateral pulmonary infiltrates suggestive of DAH. Bronchoalveolar lavage was done and showed the presence of filariform larvae, morphologically consistent with Strongyloides stercoralis. Treatment with ivermectin was started and patient responded to treatment with improvement of clinical status. In conclusion, the development of SHS in patients with lupus, especially when receiving immunosuppressive therapy, is a severe and potentially fatal complication. Early detection and treatment may decrease mortality. |
| format | Article |
| id | doaj-art-9ab4e5b1ee1e4d52bed02efc6d54220d |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-9ab4e5b1ee1e4d52bed02efc6d54220d2025-08-20T03:36:53ZengWileyCase Reports in Medicine1687-96271687-96352014-01-01201410.1155/2014/278390278390Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus ErythematosusFernando Gonzalez-Ibarra0Parag Chevli1Lindsey Schachter2Maninder Kaur3Sahar Eivaz-Mohammadi4Basheer Tashtoush5Jioty Matta6Amer K. Syed7Valentin Marian8Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USADepartment of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USADepartment of Internal Medicine, St. George’s University School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USADepartment of Internal Medicine, St. George’s University School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USADepartment of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USADepartment of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL 33331, USADepartment of Pulmonary and Critical care, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USALaureate National Institute of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USADepartment of Rheumatology, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USAThe presence of Strongyloides stercoralis infection in patients with systemic lupus erythematosus (SLE) has been described previously. Strongyloides stercoralis hyperinfection syndrome (SHS) that usually develops in patients under immunosuppressive therapy may affect a variety of organs, but the presentation with diffuse alveolar hemorrhage (DAH) is rare with only a few cases described in the literature. We present the case of a 36-year-old Hispanic female with a past medical history relevant for SLE and a recent diagnosis of lupus nephritis and hypertension. The patient who developed sudden and progressive abdominal pain and respiratory distress, with the presence of bilateral crackles and severe hypoxemia, is currently under treatment with steroids and cyclophosphamide for worsening of lupus nephritis. The patient underwent endotracheal intubation and mechanical ventilation, and computed tomography showed the presence of bilateral pulmonary infiltrates suggestive of DAH. Bronchoalveolar lavage was done and showed the presence of filariform larvae, morphologically consistent with Strongyloides stercoralis. Treatment with ivermectin was started and patient responded to treatment with improvement of clinical status. In conclusion, the development of SHS in patients with lupus, especially when receiving immunosuppressive therapy, is a severe and potentially fatal complication. Early detection and treatment may decrease mortality.http://dx.doi.org/10.1155/2014/278390 |
| spellingShingle | Fernando Gonzalez-Ibarra Parag Chevli Lindsey Schachter Maninder Kaur Sahar Eivaz-Mohammadi Basheer Tashtoush Jioty Matta Amer K. Syed Valentin Marian Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus Case Reports in Medicine |
| title | Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus |
| title_full | Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus |
| title_fullStr | Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus |
| title_full_unstemmed | Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus |
| title_short | Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus |
| title_sort | strongyloidiasis and diffuse alveolar hemorrhage in a patient with systemic lupus erythematosus |
| url | http://dx.doi.org/10.1155/2014/278390 |
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