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Ann Geriatr Med Res  <  Volume 22(4); 2018 <  Articles

Ann Geriatr Med Res 2018; 22(4): 200-203  https://doi.org/10.4235/agmr.18.0041
Acute Respiratory Distress Syndrome With Alveolar Hemorrhage due to Strongyloidiasis Hyperinfection in an Older Patient
Eun Jin Kim
Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
Correspondence to: Eun Jin Kim, MD, https://orcid.org/0000-0001-9791-8077
Department of Internal Medicine, Daegu Catholic University Medical Center, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea
Tel: +82-53-650-4274, Fax: +82-53-650-4965
E-mail: ejkim77@cu.ac.kr
Received: October 19, 2018; Revised: November 29, 2018; Accepted: December 4, 2018; Published online: December 31, 2018.
© The Korea Geriatrics Society. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Strongyloides stercoralis is an intestinal nematode that occurs sporadically in temperate areas like Korea. People who are in the immunosuppressed state, over the age of 65 or under the corticosteroid therapy are at risk for developing Strongyloides hyperinfection syndrome. Acute respiratory distress syndrome (ARDS) with alveolar hemorrhage is a rare presentation of Strongyloides hyperinfection. A 78-year-old man had been irregularly injected corticosteroid on his knees, but did not have any immunosuppressive disease. He was initially diagnosed with ARDS and septic shock. Bronchoalveolar lavage (BAL) fluid was bloody and its cytology revealed helminthic larvae identified as S. stercoralis . Results of Cytomegalovirus polymerase chain reaction (PCR), Pneumocystis jirovecii PCR, and Aspergillus antigen testing of the BAL fluid were positive. The clinical progress quickly deteriorated with multiple organ failure, shock and arrhythmia, so he finally died. This is a rare case of ARDS in an older patient without any known immunosuppressive conditions, with alveolar hemorrhage and S. stercoralis being found via BAL.
Keywords: Strongyloides stercoralis, Acute respiratory distress syndrome, Alveolar hemorrhage


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