Pulmonary strongyloidiasis--case report of 2 cases

Strongyloidiasis is a benign gastrointestinal infection. It can pass through the lungs and induce pulmonary strongyloidiasis. The suspicion of pulmonary involvement begins with clinical and chest radiographic features in the patients at risk. They are as follows: chronic lung diseases, age was 65 years, altered cellular immunity, and use of corticosteroids. Definitive diagnosis is made by identification of strongyloides in the secretion or tissue of the respiratory tract. We present 2 patients with pulmonary strongyloidiasis in this research. These 2 cases were patients with chronic obstructive pulmonary disease; both patients were more than 65 years old. They had the risk factors for severe strongyloides infection (advanced age, use of corticosteroids, an high serum cortisol level), worsening of pulmonary symptoms (e.g., dyspnea, cough, sputum production) and abnormal radiographic findings. Strongyloides stercoralis was found in the sputum and stool, and pulmonary strongyloidiasis was diagnosed. Mebendazole 100 mg twice daily was used and this eliminated the parasite from the stool in case 1, and from the sputum in case 2. Unfortunately, there was a relapse of parasite infection in case 1 and it also induced pulmonary strongyloidiasis. Finally, he died of respiratory failure. Since this disorder has a high relapse rate (15%), serial follow-up of stool and sputum is very important.