Glucocorticoids
- PDF / 170,743 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 76 Downloads / 163 Views
1 S
Strongylodiasis hyperinfection syndrome: case report A 58-year-old man developed fatal Strongylodiasis hyperinfection syndrome following treatment with prednisolone, hydrocortisone, budesonide and betamethasone for chronic obstructive pulmonary disease (COPD) or its exacerbation [not all routes and dosages stated; time to reaction onset not stated]. The man presented to an emergency department in an unconscious state, with symptoms of shortness of breath, cough with expectoration, diarrhoea and intermittent high-grade fever for 2 months and acute exacerbation of breathlessness for 4 days. His medical history was significant for COPD with difficulty in breathing for the last 10 years. He had been receiving metered-dose inhalers (MDI) budesonide [budecort] 200mg twice/day and salbutamol [levolin] for 3 years. He also received oral betamethasone (over the counter basis) during episodes of COPD exacerbations. Of note, he additionally received prednisolone 8 mg/day and IV hydrocortisone on several occasions. Following presentation, he was admitted and was intubated within a day of admission. Based on clinical history and chest X-ray findings, differential diagnosis of COPD exacerbation with pulmonary tuberculosis was made. His initial Hb count was 12.2g/dL and white cell count 23 × 109/L without eosinophilia. His blood, urine and endotracheal (ET) aspirate cultures were sterile. Thereafter, an ET aspirate with acid-fast staining demonstrated numerous larvae; however, acid-fast bacilli were absent. The microscopy of tracheal aspirate demonstrated rhabditiform larvae of Strongyloides stercoralis along with embryonated eggs, and many were observed to be in the hatching phase. Further, these findings were confirmed by iodine mount and Giemsa staining. Multiple samples of ET aspirates and gastric aspirate were examined. However, only one stool sample was obtained, probably due to intestinal obstruction. Of note, rhabditiform larvae and eggs of Strongyloides stercoralis were not found in gastric aspirate as well as in stool sample, and filariform larva wasn’t noted in any of the samples examined. The man was was nebulised with levosalbutamol and ipratropium bromide combination along with budesonide. Additionally, he was started on ivermectin. He also received a short course of IV hydrocortisone starting with 100mg, followed by 50mg 6 hourly for 3 days. Further, his clinical condition deteriorated, and he died of Strongylodiasis hyperinfection syndrome. Singh V, et al. Hatching Strongyloides in tracheal aspirate: Clinician’s dilemma; Microbiologist’s surprise. BMJ Case Reports 13: No. 10, 2020. Available from: URL: http:// 803519568 doi.org/10.1136/bcr-2020-238862
0114-9954/20/1833-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 5 Dec 2020 No. 1833
Data Loading...
