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Journal of Medical Case Reports
Published in: Journal of Medical Case Reports 1/2019

Open Access 01-12-2019 | Bronchial Asthma | Case report

Strongyloides stercoralis infection after the use of emergency corticosteroids: a case report on hyperinfection syndrome

Authors: George Vasquez-Rios, Roberto Pineda-Reyes, Eloy F. Ruiz, Angelica Terashima, Fernando Mejia

Published in: Journal of Medical Case Reports | Issue 1/2019

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Abstract

Background

In clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids. However, not all that wheezes is asthma.

Case presentation

A 61-year-old man from the Peruvian Amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. His medical history was remarkable for asthma since childhood; he was treated with beta-agonists, ipratropium, and orally administered corticosteroids. On evaluation, he was febrile and ill-appearing. His chest examination revealed diffuse wheezing and bilateral crackles. He was diagnosed as having community-acquired pneumonia and asthma exacerbation and was started on empiric antibiotics, nebulized beta-agonists, and orally administered corticosteroids. His clinical status continued deteriorating and he became critically ill despite broad-spectrum antibiotics and antifungals. Considering the epidemiological background of our patient, bronchoalveolar and fecal samples were obtained to investigate soil-transmitted helminths. Larvae of Strongyloides stercoralis were found in both specimens. Ivermectin was initiated and corticosteroids were discontinued. He experienced remarkable improvement of clinical condition over the next weeks. The literature on this topic was reviewed.

Conclusion

Cases of severe asthma exacerbation warrant careful evaluation before the initiation of corticosteroids, especially in patients at risk for parasitic infections. A high index of suspicion is critical. Alternative etiologies of respiratory decompensation should be considered in patients who fail to improve with broad-spectrum antibiotics and antifungals.
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Metadata
Title
Strongyloides stercoralis infection after the use of emergency corticosteroids: a case report on hyperinfection syndrome
Authors
George Vasquez-Rios
Roberto Pineda-Reyes
Eloy F. Ruiz
Angelica Terashima
Fernando Mejia
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2019
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-019-2022-y

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