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Fatal Strongyloides stercoralis infection in a patient receiving corticosteroids.

Report of a Case The patient, a 78-year-old Cuban man, was referred to the Los Angeles County-University of Southern California Medical Center for the treatment of severe, steroid-dependent, obstructive airways disease. The referring physician also noted that a hoarse voice, difficult deglutition and a sore throat had recently developed. There were no other gastrointestinal complaints on admission. On physical examination he had a respiratory rate of 28 per minute. An indirect laryngoscopy showed normal vocal cords. Diffuse wheezes were heard on examination ofthe chest. The leukocyte count was 4,500 per Al, with 57% segmented neutrophils, 22% band forms, 12% lymphocytes and 8% eosinophils. A sputum Gram's stain showed 3 + polymorphonuclear leukocytes and 3 + Gram-negative rods. A chest x-ray film showed no abnormalities. Because of progressive respiratory failure, an endotracheal tube was inserted and the patient was placed on mechanically assisted ventilation. Therapy with ampicillin and gentamicin sulfate was started. The patient's airways disease was managed with a regimen of hydrocortisone, aminophylline and metaproterenol sulfate. Despite vigorous therapy, the patient became comatose and hypotensive and died on the third hospital day. On gross examination at autopsy, the pharynx was clear of lesions, but the trachea showed extensive hyperemia. The gastrointestinal tract from the stomach to the large intestine showed areas of mucosal erosion. Microscopic examination of lung tissue disclosed Strongyloides stercoralis organisms in large numbers, with histiocytic infiltrates surrounding the organisms (Figure 1). On microscopic examination of duodenum and jejunum, many S stercoralis organisms were seen