A Rare Case of an Eosinophilic Pleural Effusion and Loculated Ascites Associated with Strongyloides stercoralis Hyperinfection Syndrome in California

Abstract

Introduction. Strongyloides stercoralis causes a helminthic infection that occurs via penetration of the skin with migration to the bloodstream, tracheobronchial tree, and gastrointestinal system. Pulmonary manifestations are rare and are typically seen in immunosuppressed patients who have Strongyloides stercoralis hyperinfection syndrome. Eosinophilic pleural effusions are rare in strongyloidiasis and only cited in a few case reports. Case Presentation. A 45-year-old male with a past medical history of diabetes mellitus, alcoholic cirrhosis, and end-stage renal disease presented to the emergency department with abdominal pain and dyspnea. Imaging studies demonstrated large bilateral pleural effusions, and he subsequently underwent an ultrasound-guided thoracentesis on the right hemithorax, yielding an exudative eosinophilic pleural effusion. An extensive hematology, gastroenterology, and infectious work-up was pursued. Strongyloides immunoglobulin G was positive, and he was successfully treated with ivermectin. Discussion. Eosinophilic pleural effusions related to strongyloidiasis are exceedingly rare. Clinicians should consider Strongyloides stercoralis infection as a part of the differential diagnosis when evaluating immunosuppressed patients with eosinophilic pleural effusions. Loculated abdominal fluid may also be a rare manifestation of Strongyloides stercoralis hyperinfection syndrome.