Namisato Shun, Motomura Kazuhisa, Haranaga Shusaku, Hirata Tetsuo, Toyama Masato, Shinzato Takashi, Higa Futoshi, Saito Atsushi
First Department of Internal Medicine, Faculty of Medicine University of the Ryukyus, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215.
Intern Med. 2004 Aug;43(8):731-6. doi: 10.2169/internalmedicine.43.731.
Strongyloidiasis is widely distributed in tropical and subtropical areas. Disseminated strongyloidiasis may develop in patients with immunodeficiencies. In the absence of early diagnosis and treatment, the prognosis of disseminated strongyloidiasis is extremely poor. We report a case of pulmonary strongyloidiasis that was successfully treated. The patient was an 83-year-old woman who had been receiving long-term oral prednisolone therapy for uveitis. The patient visited our emergency department complaining of breathing difficulties and diarrhea. A chest X-ray revealed a diffuse enhancement of interstitial shadows. A bronchoalveolar lavage (BAL) was performed, and both Gram staining and Grocott's staining revealed the presence of multiple filariform larvae of Strongyloides stercoralis in the bronchoalveolar lavage fluid (BALF). A stool examination performed at the same time also yielded S. stercoralis. The patient was diagnosed as having pulmonary strongyloidiasis and was treated with thiabendazole and ivermectin, in addition to antimicrobial agents; her respiratory symptoms and diarrhea improved, and S. stercoralis was not detected in subsequent follow-up examinations thereafter. In endemic areas of S. stercoralis, pulmonary strongyloidiasis should be considered as part of a differential diagnosis if chest imaging findings like alveolar and interstitial shadow patterns or lobar pneumonia are seen in patients with immunodeficiencies.
粪类圆线虫病广泛分布于热带和亚热带地区。播散性粪类圆线虫病可发生于免疫缺陷患者。若未早期诊断和治疗，播散性粪类圆线虫病的预后极差。我们报告一例成功治愈的肺粪类圆线虫病病例。患者为一名83岁女性，因葡萄膜炎长期接受口服泼尼松龙治疗。患者因呼吸困难和腹泻就诊于我院急诊科。胸部X线显示间质阴影弥漫性增强。进行了支气管肺泡灌洗（BAL），革兰染色和Grocott染色均显示支气管肺泡灌洗液（BALF）中存在多条粪类圆线虫丝状蚴。同时进行的粪便检查也发现了粪类圆线虫。患者被诊断为肺粪类圆线虫病，除抗菌药物外，还接受了噻苯达唑和伊维菌素治疗；其呼吸道症状和腹泻有所改善，此后的后续检查中未检测到粪类圆线虫。在粪类圆线虫流行地区，对于免疫缺陷患者，若胸部影像学检查发现肺泡和间质阴影模式或大叶性肺炎等表现，应将肺粪类圆线虫病纳入鉴别诊断。
