Abstract Strongyloides stercoralis is an intestinal nematode endemic in tropical and subtropical regions with the capacity for auto infection allowing lifelong persistence in humans. While chronic infection may remain asymptomatic, immunosuppression can lead to hyperinfection or disseminated strongyloidiasis, with dissemination beyond the gastrointestinal and pulmonary systems. Pleural involvement remains rare, with few documented cases in the literature. This is the case of an 80-year-old male with past medical history of hypertension, thymoma, s/p thymectomy and squamous cell carcinoma of the tongue s/p radiotherapy that presented to the emergency department with right side chest pain that worsened with inspiration. Patient reports symptoms of dry cough, progressive weakness, lack of appetite, fatigue and general malaise. He had a 5-pack-year smoking history and resided in rural, strongyloidasis-endemic region (Puerto Rico), reports swimming in rivers and while serving deploymenet he was assigned to Vietnam and Kuwait. Chest x-ray showed a large right side pleural effusion and CT scan of chest with findings of right-sided pleural effusion with underlying pleural thickening and nodularity, a 5.6 x 4.3 cm lobulated heterogenous lesions noted in the right major fissure with associated adjacent fluid. Patient underwent therapeutic and diagnositic thoracentesis of 1500 mL straw colored, exudative fluid with 46% of eosinophils. Cytology with findings of atypical squamous cells consistent with malignancy and numerous filariform larvea morphologically consistent with Strongyloides stercoralis were identified in the pleural fluid smear. Pleural biopsy via CT guided biopsy, confirmed metastatic squamous cell carcinoma with no granulomas or eosinophilic infiltrates. The patient was started on Ivermectin therapy for two weeks and was consulted with Oncology services for further management. Patient initially improved yet his condition deteriorated and he expired three weeks later under hospice care. Strongyloides stercoralis is a parasitic nematode that can cause chronic asymptomatic infection but may result in life-threatening hyperinfection in immunocompromised individuals. Involvement of the pleural space is exceedingly rare. This case highlights the necessity for comprehensive cytological examination of pleural fluid, including evaluation for parasitic organisms, particularly in endemic areas. Further research is warranted to elucidate the pathophysiological mechanisms underlying such co-infections and to determine their impact on disease progression and patient outcomes. This abstract is funded by: none
Gorbea et al. (Fri,) studied this question.