SESSION TITLE: Student/Resident Chest Infections SESSION TYPE: Student/Resident Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 11:00 AM - 12:00 PM INTRODUCTION: Strongyloides stercoralis is an intestinal parasite endemic in tropical and subtropical regions. We report an unusual case of respiratory failure and diffuse alveolar hemorrhage secondary to S. stercoralis hyperinfection syndrome. CASE PRESENTATION: The patient is a 42-year-old male with a past medical history of asthma and deep vein thrombosis who presented with diffuse abdominal pain, anorexia, vomiting, diarrhea and dizziness for approximately one week. Patient also noted a painful penile ulcerated lesion for three days prior to admission. Patient was taking PO dexamethasone chronically for his asthma. His physical exam was remarkable for diffuse abdominal tenderness, an erythematous, maculopapular rash with occasional pustules over anterior abdomen, and erythematous vesicular lesions on the shaft and head of penis. Labs were remarkable for an elevated WBC count without eosinophilia, hyponatremia, mild hypokalemia, and hypoalbuminemia. Abdominal CT scan demonstrated bowel wall thickening and inflammatory stranding involving the cecum, ascending colon, and transverse colon concerning for colitis and stool cultures showed heavy growth of S. stercoralis. Patient was started on albendazole at this time. Colonic biopsy revealed changes consistent with strongyloides-associated colitis. On hospital day 5, he developed acute hypoxic respiratory failure from strongyloides superinfection and was intubated. Bronchoscopy with broncheoalveolar lavage revealed friable mucosa seen diffusely and S. stercoralis isolated from gram stain smear. Patient switched to ivermectin due to known superior efficacy compared to albendazole and indication in suspected superinfection, however due to the patient developing an ileus with NG set to suction, FDA approval was required for subcutaneous dosing (which is only available in veterinary forms) and obtained from outside veterinarian hospital. Patient was extubated on hospital day 10, and his pan colitis resolved over the course of two weeks on therapy. DISCUSSION: Patient showed significant clinical improvement after subcutanous ivermectin treatment, warranting further infestigation into dosing and toxicity of therapy in S. stercoralis superinfection. CONCLUSIONS: S. stercoralis is an uncommon cause for diffuse alveolar hemorrhage; however, in an immunocompromised patient from an endemic area, a strong clinical suspicion is warranted as delay in diagnosis carries a high mortality rate. Reference #1: Annick Datry, Ingibjôrg Hilmarsdottir, Rubén Mayorga-Sagastume, Mohamed Lyagoubi, Philippe Gaxotte, Sylvestre Biligui, Jeff Chodakewitz, Donald Neu, Martin Danis, Marc Gentilini, Treatment of Strongyloides stercoralis infection with ivermectin compared with albendazole: results of an open study of 60 cases, Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 88, Issue 3, 1994, Pages 344-345, ISSN 0035-9203, http://dx.doi.org/10.1016/0035-9203(94)90110-4. DISCLOSURE: The following authors have nothing to disclose: Daniel Mathew, Shyam Kapadia, Ricardo Restrepo-Jaramillo, Stephen Clum No Product/Research Disclosure Information