Rapidly progressive respiratory failure after helminth larvae ingestion

BMC Pulmonary Medicine

Chetan Naik¹  Susan K. Mathai¹  Balaji Kolasani²  Anahit A. Zeynalyan³  Christopher J. G. Sigakis⁴  Leann Silhan⁵ 

[1] Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA;Department of Internal Medicine - Pulmonary Research, UT Southwestern Medical Center, Dallas, Texas, USA;Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Ave, 75246, Dallas, Texas, USA;Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA;Leann Silhan, MD PLLC, Dallas, Texas, USA;

关键词: Löffler’s syndrome;    Helminth therapy;    Pulmonary arterial hypertension;    Systemic sclerosis;    Scleroderma;    Eosinophilic lung disease;   

DOI  :  10.1186/s12890-021-01788-w

来源: Springer

【 摘 要 】

BackgroundSelf-administration of helminths has gained attention among patients as a potential but unproven therapy for autoimmune disease. We present a case of rapidly progressive respiratory failure in a patient with systemic sclerosis (SSc) and pulmonary arterial hypertension (PAH) as a result of self-administration of parasitic organisms.CaseA 45-year-old woman with a history of interstitial lung disease and PAH due to limited cutaneous SSc presented to pulmonary clinic with worsening dyspnea, cough, and new onset hypoxemia. Three months prior to presentation she started oral helminth therapy with Necator americanus as an alternative treatment for SSc. Laboratory evaluation revelaed eosinophilia and elevated IgE levels. IgG antibodies to Strongyloides were detected. High resolution computed tomography of the chest revealed progressive ILD and new diffuse ground glass opacities. Transthoracic echocardiogram and right heart catheterization illustrated worsening PAH and right heart failure. The patient was admitted to the hospital and emergently evaluated for lung transplantation but was not a candidate for transplantation due to comorbidities. Despite aggressive treatment for PAH and right heart failure, her respiratory status deteriorated, and the patient transitioned to comfort-focused care.ConclusionAlthough ingestion of helminths poses a risk of infection, helminth therapy has been investigated as a potential treatment for autoimmune diseases. In this case, self-prescribed helminth ingestion precipitated fatal acute worsening of lung inflammation, hypoxemia, and right heart dysfunction, highlighting the risk of experimental helminth therapy in patients, especially those with underlying respiratory disease.

【 授权许可】

CC BY