Severe hemodynamic compromise, respiratory failure and disseminated skin lesions due to Strongyloides stercoralis

Introduction

Strongyloides stercoralis is an intestinal nematode, endemic in tropical and subtropical regions and of a great importance in Brazil, that induces a chronic infection in humans, usually asymptomatic. Mainly in immunocompromised individuals, such as patients with AIDS, malignancy, and receiving corticosteroids or immunosuppressors, this parasite can cause hyperinfection with systemic manifestations.

Case report

We report a case of disseminated Strongyloidiasis in a 64-year-old patient with COPD and chronic use of corticosteroids, presenting with acute respiratory failure, bilateral interstitial infiltrate, needing mechanical ventilation, associated with septic shock, meningitis caused by Enterococcus and purpuric skin lesions. The diagnosis was done by sputum analysis and responded to thiabendazole and ivermectin.

Discussion

Thiabendazole has been used in Strongyloides infestation, and cure rates of 60% have been achieve in immunocompetent patients with hyperinfection who receive prompt therapy, but the mortality approaches 75% in immunocompromised patients. Recently, ivermectin has been used in severe and resistant cases of S. stercoralis dissemination.

Conclusion

It is important to search for Strongyloides in the sputum of imunosupressed patients presenting with acute respiratory failure and skin manifestation in tropical countries for earlier diagnostic and successful treatment.