CASE REPORT: PDF OnlyStrongyloides stercoralisHyperinfection Presenting With Symptoms Mimicking Acute Exacerbation of Chronic Obstructive Pulmonary DiseaseLiu, Hsu-Chunga, b; Hsu, Jeng-Yuana, c; Chang, Ki-Minga, *Author Information aDivision of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. bDivision of Chest Medicine, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan, R.O.C. cInstitute of Medicine, Chung-Shan Medical University, Taichung, Taiwan, R.O.C. *Correspondence to: Dr Ki-Ming Chang, Division of Chest Medicine, Taichung Veterans General Hospital, 160, Section 3, Chung-Kang Road, Taichung 407, Taiwan, R.O.C. E-mail: [email protected] Received: November 14, 2008; • Accepted: May 19, 2009. Journal of the Chinese Medical Association: August 2009 - Volume 72 - Issue 8 - p 442-445 doi: 10.1016/S1726-4901(09)70403-4 Metrics Abstract Hyperinfection syndrome with Strongyloides stercoralis is not uncommon in immunocompromised patients. We present 2 fatal cases of Strongyloides hyperinfection with initial presentation mimicking acute exacerbation of chronic obstructive pulmonary disease (COPD). Both cases had a history of COPD and had received systemic steroid treatment before or during admission. The initial chest radiograph in both of these cases showed diffuse axial interstitial pattern. The sputum examinations of Gram stain both yielded larvae of Strongyloides stercoralis precipitously. Case 1 developed acute respiratory distress syndrome and bacteremia of Escherichia coli and Klebsiella pneumoniae soon after admission, and died even after receiving albendazole and antibiotic treatment. Case 2 received albendazole and antibiotic treatment for over 2 weeks, but developed refractory aseptic meningitis and died of septic shock. Neither case had high eosinophil count in peripheral blood during admission. Clinical manifestations of unexplained wheezing and respiratory failure, increased infiltration on chest radiograph, Gram-negative bacteremia, and aseptic meningitis may all be clues of Strongyloides hyper-infection. Due to the high mortality rate and severe complications in these patients, clinicians should always keep this diagnosis in mind, especially when dealing with immunocompromised patients. We suggest that a screening test be done for patients who live in endemic areas and those who are going to receive steroids for chronic disease. © 2009 by Lippincott Williams & Wilkins, Inc.