Case of Strongyloides hyperinfection syndrome

Description

A woman aged 36 years with untreated AIDS presented with symptoms of abdominal pain, increasing dyspnoea with haemoptysis and weight loss. Prior to arrival in the USA, she lived in the Democratic Republic of Congo. She was afebrile, and had bilateral expiratory wheezing on examination. T-helper CD4 cell count was 106 (9%) and HIV PCR quantification was 1 146 362 copies/mL. A CT scan revealed bilateral ground glass opacities, diffuse small bowel wall thickening and mild hepatosplenomegaly. A bronchoscopy with bronchoalveolar lavage (BAL) showed 11 nucleated cells/μL noted (11% neutrophils, 4% lymphocytes, 77% mononuclear cells and 8% eosinophils). BAL microscopy noted live Strongyloides larvae (video 1 and figure 1). Cytopathology studies were also notable for the presence of Strongyloides stercoralis larvae (figure 2). Blood cultures grew Klebsiella pneumoniae. This clinical amalgamation of enteritis, Gram-negative rod bacteraemia and pulmonary invasion of filariform larvae is classic...

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