PULMONARY STRONGYLOIDIASIS IN TREATED MULTIPLE SCLEROSIS

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Several parasitic infections can occur in immunocompromised hosts either from a primary acquired infection such as Cryptosporidium or reactivation of previously Toxoplasma. Among these infections, Strongyloides stercolaris is the only helminth responsible for disseminated people.Over past years, several disease modifying agents have been approved multiple sclerosis (MS) among which we note Ocrelizumab, an anti-CD20 monoclonal antibody. This has associated with increased risk especially hepatitis B and herpes. CASE PRESENTATION: We describe case 37 year old man originally Honduras, United States more than 15 who presented initially week worsening abdominal pain, nausea, vomiting diarrhea. Noted that he had prior to treated 5-day course intravenous steroids MS flare. Presenting vitals were blood pressure 93/57, heart rate 112 bpm, high grade temperature (40.3 C) respiratory 20/min. Clinical examination was remarkable bilateral expiratory wheezes diffuse tenderness. His workup showed marked eosinophilia progressively absolute eosinophil count up 12000 4000 on admission. A CT abdomen ground glass opacities lower cuts chest followed by dedicated showing GGO shown attached picture. Given suspicion possible disease, prophylactic ivermectin started. bronchoscopy performed BAL markedly edematous airways, minimal return BAL, 46% eosinophils differential fluid negative microscopy. stool microscopic analysis ova parasites significant amount larvae. DISCUSSION: While asymptomatic most immunocompetent people, even one adult parasite female multiply rapidly alteration host immune defenses use other drugs. Pulmonary forms be fatal described secondary ARDS pulmonary hemorrhage. add literature patient Ocrelizumab likely precipitated short steroids. biologic therapies are considered trigger immunosuppression cancer patients those rheumatological conditions, this emphasizes immunosuppressive states new emerge. CONCLUSIONS: Severe eosinophilic acute findings should highly raise receiving steroid therapy. REFERENCE #1: Derouin F. Parasitoses des immunodéprimés [Parasitic patients]. Rev Prat. 2007 Jan 31;57(2):167-73. French. PMID: 17432521. #2: Ramanathan, R., & Nutman, T. (2008). stercoralis host. Current infvectious reports, 10(2), 105–110. #3: Nabeya D, Haranaga S, Parrott GL, Kinjo T, Nahar Tanaka Hirata Hokama A, Tateyama M, Fujita J. strongyloidiasis: assessment between manifestation radiological 16 severe strongyloidiasis cases. BMC Infect Dis. 2017 May 2;17(1):320. doi: 10.1186/s12879-017-2430-9. 28464844; PMCID: PMC5414214. DISCLOSURES: No relevant relationships Jalil Ahari, source=Web Response Ammar Alhaddad, Sandrine Hanna,