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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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Wait!!! No Steroids for this Asthma….

Abdelhamid Alsharif1, Amik Sodhi1, Luis C Murillo1

  • 1Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, College of Medicine at Memphis, Memphis, TN, USA.

The American Journal of Case Reports
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Asthma patients from Strongyloides stercoralis endemic areas should be screened for the parasite before steroid treatment. Steroids can worsen Strongyloides stercoralis infections, leading to severe hyperinfection syndrome.

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Area of Science:

  • Medical Parasitology
  • Pulmonology
  • Infectious Diseases

Background:

  • Strongyloides stercoralis (SS) is a parasitic infection prevalent in certain US regions and endemic areas globally.
  • Corticosteroid use in patients with SS can precipitate or exacerbate asthma, potentially leading to severe complications like hyperinfection syndrome or death.

Observation:

  • A young woman with asthma presented with symptoms including wheezing, cough, and abdominal pain.
  • Diagnostic workup revealed Strongyloides stercoralis in stool and bronchoalveolar lavage, alongside pulmonary infiltrates consistent with hyperinfection syndrome.
  • The patient's condition was likely exacerbated by prednisone treatment for her asthma.

Findings:

  • Discontinuation of steroids and initiation of ivermectin treatment led to clinical improvement.
  • Post-treatment stool examinations were negative for Strongyloides stercoralis, indicating successful parasite clearance.

Implications:

  • Clinicians must exercise caution when prescribing steroids to asthma patients from SS-endemic regions.
  • Pre-treatment screening for Strongyloides stercoralis, preferably via serology, is recommended before initiating steroid therapy in at-risk populations.