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An unusual cause of pleural effusion

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Q1. What is the clinical diagnosis?

Diabetic ketoacidosis and disseminated strongyloidiasis resulting in Gram negative sepsis and empyema thoracis from enterobacteriaceae.

Q2. What is the parasite?

The filariform larva of Strongyloides stercoralis, an intestinal nematode seen in tropical and subtropical countries.

Q3. What are the conditions predisposing to this kind of presentation?

Various conditions predisposing to disseminated strongyloidiasis are given in box 1.

Box 1 Risk factors for disseminated strongyloidiasis

  • Immunosuppressive therapy (particularly corticosteroids)

  • Organ transplantation

  • Haaematological malignancy

  • Human T lymphotropic virus 1 infection

  • HIV infection

  • Malnutrition

  • Diabetes mellitus

  • Chronic renal failure

  • Chronic alcoholism

Some cases may have no identifiable risk factor for immunodeficiency.

Discussion

The patient developed moderately severe diabetic ketoacidosis because of sepsis and the omission of insulin injections. The severity of ketoacidosis had been assessed to optimise the management and monitoring of the patient.1 Diabetes mellitus is a predisposing factor for the dissemination of Strongyloides stercoralis infection,2 the manifestations of which include ARDS, pleural effusions, ascites, haemorrhagic colitis, and meningitis. The invasion of the gut by the parasite predisposes to …

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    A Reghukumar V Chandran J M Pappachan J Antony K Vijayakumar