Yashwanth Raj T, Vairakkani R, Harshavardhan T S, Srinivasaprasad N D, Dilli Rani V, Edwin Fernando M
Department of Nephrology and Microbiology, Government Stanley Medical College, The TN Dr. MGR Medical University, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2020 Mar-Apr;30(2):121-124. doi: 10.4103/ijn.IJN_141_19. Epub 2020 Jan 3.
A 28-year-old male, 3 years post renal transplant with stable graft function, presented with vomiting for 2 days. He had graft dysfunction and graft biopsy done revealed acute cell - mediated rejection BANFF-IA. After receiving glucocorticoids for rejection, he developed severe enterocolitis and impending respiratory failure. Chest X-ray and computed tomography of the chest revealed miliary mottling. Evaluation showed presence of filariform larvae of Strongyloides stercoralis in the stool and sputum. A diagnosis of Strongyloides Hyperinfection Syndrome (SHS) was made. After a prolonged course of treatment with noninvasive ventilation, broad-spectrum antimicrobials, parenteral ivermectin and oral albendazole therapy, he eventually recovered. This case report is to highlight that Strongyloides Hyperinfection Syndrome should also be considered in the differential in any immunocompromised patient presenting with miliary mottling in imaging.
一名28岁男性，肾移植术后3年，移植肾功能稳定，出现呕吐2天。他出现移植肾功能障碍，移植肾活检显示为急性细胞介导性排斥反应（BANFF-IA级）。在接受糖皮质激素治疗排斥反应后，他发展为严重的小肠结肠炎并即将出现呼吸衰竭。胸部X线和胸部计算机断层扫描显示粟粒状斑纹。检查发现粪便和痰液中有粪类圆线虫丝状蚴。诊断为类圆线虫超感染综合征（SHS）。经过长时间的无创通气、广谱抗菌药物、肠外伊维菌素和口服阿苯达唑治疗，他最终康复。本病例报告旨在强调，对于任何在影像学上出现粟粒状斑纹的免疫功能低下患者，鉴别诊断时也应考虑类圆线虫超感染综合征。
