TY - JOUR
T1 - Strongyloides stercoralis hyperinfection in a patient with rheumatoid arthritis after anti-TNF-α therapy
AU - Krishnamurthy, Raghu
AU - Dincer, H. Erhan
AU - Whittemore, Darren
PY - 2007/6
Y1 - 2007/6
N2 - Strongyloidiasis is epidemic in tropical and subtropical regions where the regional prevalence may exceed 25%. In the United States, highest infection rates are found in immigrants. Many infected individuals are asymptomatic, whereas others may have mild and nonspecific cutaneous, intestinal, and pulmonary symptoms. Strongyloides stercoralis may remain as a dormant infection, but replication and dissemination can be fatal in immunocompromised patients. We report on a 63-year-old native Filipino man with a history of rheumatoid arthritis who developed Escherichia coli sepsis, filariform larvae characteristic of S. stercoralis bronchoalveolar lavage, and adult respiratory distress syndrome 3 weeks after he presented with vague gastrointestinal symptoms. We believe that the addition of a tumor necrosis factor (TNF)-α inhibitor to his treatment with prednisone and methotrexate for rheumatoid arthritis further suppressed his cellular immunity leading to hyperinfection and life-threatening S. stercoralis infection. This is another, often latent, infection that should be considered in patients in or from endemic areas before institution of antitumor necrosis factor therapy.
AB - Strongyloidiasis is epidemic in tropical and subtropical regions where the regional prevalence may exceed 25%. In the United States, highest infection rates are found in immigrants. Many infected individuals are asymptomatic, whereas others may have mild and nonspecific cutaneous, intestinal, and pulmonary symptoms. Strongyloides stercoralis may remain as a dormant infection, but replication and dissemination can be fatal in immunocompromised patients. We report on a 63-year-old native Filipino man with a history of rheumatoid arthritis who developed Escherichia coli sepsis, filariform larvae characteristic of S. stercoralis bronchoalveolar lavage, and adult respiratory distress syndrome 3 weeks after he presented with vague gastrointestinal symptoms. We believe that the addition of a tumor necrosis factor (TNF)-α inhibitor to his treatment with prednisone and methotrexate for rheumatoid arthritis further suppressed his cellular immunity leading to hyperinfection and life-threatening S. stercoralis infection. This is another, often latent, infection that should be considered in patients in or from endemic areas before institution of antitumor necrosis factor therapy.
KW - Strongyloidiasis
UR - http://www.scopus.com/inward/record.url?scp=34249980099&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34249980099&partnerID=8YFLogxK
U2 - 10.1097/RHU.0b013e3180690933
DO - 10.1097/RHU.0b013e3180690933
M3 - Article
C2 - 17551383
AN - SCOPUS:34249980099
SN - 1076-1608
VL - 13
SP - 150
EP - 152
JO - Journal of Clinical Rheumatology
JF - Journal of Clinical Rheumatology
IS - 3
ER -