Table of Contents Author Guidelines Submit a Manuscript
Case Reports in Medicine
Volume 2014 (2014), Article ID 278390, 3 pages
http://dx.doi.org/10.1155/2014/278390
Case Report

Strongyloidiasis and Diffuse Alveolar Hemorrhage in a Patient with Systemic Lupus Erythematosus

1Department of Internal Medicine, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA
2Department of Internal Medicine, St. George’s University School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA
3Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, Weston, FL 33331, USA
4Department of Pulmonary and Critical care, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA
5Laureate National Institute of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA
6Department of Rheumatology, Mount Sinai School of Medicine, Jersey City Medical Center, 355 Grand Street, Jersey City, NJ 07302, USA

Received 26 March 2014; Accepted 28 May 2014; Published 12 June 2014

Academic Editor: Christian Koch

Copyright © 2014 Fernando Gonzalez-Ibarra et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.