Dancing Dragons: A tale of 2 Intriguing Cases

Thilagavanthy¹, Anitha Jasmine²

Department of Microbiology, Kauvery Hospital, Cantonment, Trichy

Case presentation

Case 1

A 74-year-old female with h/o COPD, CAP on bipap, Rheumatoid arthritis on steroids, presented with acute onset of breathlessness and loose stools for 3days.

A tracheal secretion sample was sent for culture and fungal stain, the wet mount revealed motile larvae of strongyloides stercoralis.

Discussed with Dr. Dominic, a stool was also examined, confirming the presence of larvae.

Diagnosis: Disseminated strongyloidasis.

Case 2

A 70-year-old male, diagnosed with CLL, not on any active treatment presented with h/o acute onset cough and cold, fever. No h/o abdominal pain or loose stools.

Diagnostic BAL was done and sample sent for culture and fungal stain, wet mount revealed single larvae, not motile, aroused suspicion.

Discussed with Dr. Ramasubramaniyan, and a consecutive stool specimen obtained while revealed motile larvae

Diagnosis: Disseminated Strongyloidasis

Clinical takeaway

Immunocompromised doesn’t always mean in chemotherapy, the disease itself can predispose to atypical infection.
Strongyloides infection can present with no GI symptoms.
Think parasitic infection as Differential Diagnosis in immunocompromised, hematological malignancies.
Both the cases it’s respiratory specimen which clinched the diagnosis even when it is Disseminated. Fungal stain helped in parasitic diagnosis!!