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Broncho-alveolar lavage is very useful in early diagnosis of invasive pulmonary strongyloidiasis
- Karumathil Madathil Murali, Ajith Kumar VK, Vishnu Prasad (12 July 2006)
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Karumathil Madathil Murali, Physician Malabar Institute of Medical Sciences, Calicut, India, Ajith Kumar VK, Vishnu Prasad
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km_murali{at}hotmail.com Karumathil Madathil Murali, et al.
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Dear Editor, We encountered a patient who presented with acute onset of shortness of breath after two days of diarrhea, while being on prednisolone and cyclophohsphamide for nearly 4 weeks for adult onset nephrotic syndrome. Chest X-ray showed bilateral extensive infiltrates and differential diagnosis of bilateral pneumonia vs pulmonary edema were cnosidered. Patient rapidly deteriorated and had to be intubated on day 2 of presentation and a broncho-alveolar lavage done after patient was on a ventilator showed the lashing larvae of strongyloides. Larvae were also isolated from the stool of the patient. Patient was treated with ivermectin and broad coverage for gram negative sepsis. As highlighted in literature invasive strongyloidiasis has a high mortality primarily from associated gram negative sepsis due to bacterial migration along tracks left by vigorous bowel wall traffic of the larvae to the blood stream. Our patient remained on a ventilator for 45 days due to severe ARDS, but ultimately survived. I am sending a video clip of the lashing larvae which is very striking when the BAL is examined fresh Video: Lasing larvae of invasive strongylodiasis from BAL. Figure 1
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