Respiratory hyperinfection caused by Strongyloides stercoralis in a patient with pemphigus vulgaris and minireview on diagnosis and treatment of strongyloidiasis

We explain a case of strongyloidiasis in a woman with pemphigus vulgaris from the north of Iran. The patient, aged 59 years old, had been receiving immunosuppressive therapy (oral prednisone) for the last 1 year. She presented with a recent history of diarrhea, epigastric pain, vomiting, fever, loss of consciousness, and respiratory failure. Biochemical and hematological findings were abnormal, and eosinophilia was remarkable. Bronchoscopic alveolar lavage and stool examination revealed larval forms of Strongyloides stercoralis as well as severe acute inflammation. A chest X-ray revealed alveolar opacity in the bilateral mid- and lower zones and bilateral blunting of the costopherenic angle. The high-resolution computed tomography findings showed diffuse ground glass and alveolar opacity, bilateral pleural effusion, and multiple cavitary lesions in mid- and lower zones of the lung. The patient responded well to the treatment with ivermectin plus albendazole.