Abstract: TH-PO589
Diffuse Alveolar Hemorrhage with Respiratory Failure: A Case of Strongyloides Hyperinfection Post Renal Transplantation
Session Information
- Trainee Case Reports - II
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 1802 Transplantation: Clinical
Authors
- Hakeem, Imtiyaz H., Baylor Scott & White Health/Texas A&M COM-HSC, Temple, Texas, United States
- Pinal, Cristina E., Baylor Scott & White Health/Texas A&M COM-HSC, Temple, Texas, United States
- Khan, Faiza N., Baylor Scott & White Health/Texas A&M COM-HSC, Temple, Texas, United States
Introduction
Strongyloides Stercoralis is an intestinal nematode which infects millions of people. It is endemic in South Asia, Latin America, Sub Saharan Africa and South Eastern United States.
The infection usually is asymptomatic but can be serious in the immunocompromised Host.
Case Description
We present 60 y.o.African American Male an Army Veteran 2 months post Deceased Donor Renal Transplant on Immunosuppression.
He presented with 10 days of severe fatigue, weight loss, cough, and multiple loose stools every day.
He was born in Central Texas and lived most of his life in this area. He had no travel to Asia or the Middle East. Visited Mexico and Florida a few times in the remote past.
Initial imaging was consistent with pulmonary infiltrates. Progressive Anemia with pulmonary infiltrates prompted Bronchoscopy with BAL which revealed Diffuse Alveolar Hemorrhage. Started on high dose pulse steroids, plasmapheresis. Intubated for Respiratory failure..
ANCA, APS, Anti-GBM, ANA profile was negative and kidney biopsy showed no evidence of vasculitis.
Repeat BAL was positive for the larval forms of Strongyloides. Diffuse purpuric rash on abdomen, punch Biopsy revealed Strongyloides larvae. Stool O&P returned positive for the Strongyloides, but ELISA was negative..
He was started on subcutaneous Ivermectin and albendazole but showed no improvement. Irreversible septic shock ensued resulting in death.
His pre transplant serum returned negative for Strongyloides antibody. Donor serum returned positive for Strongyloides.
liver and lung tissues showed larval forms on autopsy.
Discussion
The global burden caused by Strongyloides stercoralis is not completely known. Humans become infected when filariform larva penetrates the skin or mucosa. Hyperinfection happens in immunocompromised hosts when reduced immunosurveillance leads to unrestricted proliferation of the worms. In hyperinfection, enteric bacteria can be carried by larvae which results in fatal septicemia.
The American Society for Transplantation guidelines recommend screening for Strongyloides in recipients from endemic areas with no mention of donor screening
Increased suspicion, surveillance, and screening of the donors and recipients from the endemic areas is needed to avoid any fatal effects of the superinfection in transplant recipients.