2025 Volume 3 Issue 2 Pages 98-104
A 63-year-old man from Okinawa prefecture presented at our hospital with anemia, weight loss, abdominal distension, constipation, and a dry cough. Alveolar hemorrhage developed in the patient during his visits to the hospital. Strongyloides stercoralis was identified in both duodenal specimen and bronchoalveolar lavage fluid, leading to a diagnosis of alveolar hemorrhage due to Strongyloides infection. However, the patient died from respiratory failure and hemorrhagic shock before receiving ivermectin treatment. A postmortem autopsy confirmed disseminated strongyloidiasis, and extensive alveolar hemorrhage and diffuse alveolar damage were found in both lungs, which was the main cause of the death. Contributing factors to the severity of the disease included a human T-cell leukemia virus type 1 (HTLV-1) carrier and malnutrition. Strongyloides stercoralis can autoinfect, and in individuals using immunosuppressants or infected with HTLV-1, hyperinfection and disseminated infection to systemic organs may occur. The mortality rate from disseminated strongyloidiasis was high, underscoring the importance of early diagnosis. Patients who have lived in Okinawa, Amami, or southern Kyushu may experience gastrointestinal symptoms such as constipation and abdominal pain, or acute respiratory failure. Respiratory symptoms such as alveolar hemorrhage could be an early indicator of strongyloidiasis, necessitating thorough examinations and a high index of suspicion for this disease.
