An unusual cause of pulmonary haemorrhage in a patient with rheumatoid arthritis
Koh, M.S.; Leng, P.H.; Eng, P.; Hwang, J.
Annals of the Academy of Medicine Singapore 33(3): 365-367
2004
ISSN/ISBN: 0304-4602 PMID: 15175782 Document Number: 575314
Introduction: Pulmonary haemorrhage is a rare presentation of strongyloides hyperinfection. Clinical Picture: A 69-year-old female patient with rheumatoid arthritis on methotrexate and prednisolone presented with severe community acquired pneumonia. Intravenous trimethoprim/sulfamethoxazole (bactrim) and high dose hydrocortisone for Pneumocystis carinii pneumonia were commenced. She developed pulmonary haemorrhage 2 weeks later and bronchoalveolar lavage cytology revealed helminthic larvae identified as strongyloides. Treatment and Outcome: Despite treatment with ivermectin and albendazole with rapid tailing down of hydrocortisone, she succumbed to her illness. Conclusions: Strongyloides hyperinfection should be considered in an immunocompromised patient on high dose corticosteroid presenting with pulmonary haemorrhage. Prognosis remains dismal as supported by our case report and current literature.