Abstract:

On November 3, 2021, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine admitted a 67-year-old male patient with “cough and space-occupying lesions in the right lung”. The patient complained of repeated cough and expectoration for more than 50 years. The symptoms worsened half a month ago. Chest CT in the external hospital showed space-occupying lesions in the lung. He had a history of contact with cats and dogs. He had been treated elsewhere for skin pruritus and rash. After admission, active Strongyloides stercoralis was found in sputum and feces by microscopic examination. Chest enhanced CT suggest lung cancer in the dorsal segment of the lower lobe of the right lung (25 mm × 24 mm), small nodules in the upper and lower lobes of both lungs and possible metastasis cannot be excluded; the bronchoscopy showed that the right main bronchus was unobstructed, the upper lobe and lower lobe bronchus, as well as each segment and sub-segment bronchus, were unobstructed, the mucosa was congested, a small amount of white discharge was seen, and no neoplasm was found. S. stercoralis (290 sequences) and Nocardia otitidiscaviarum (102 sequences) were detected in alveolar lavage fluid next-generation sequencing. Nocardia was found in the alveolar lavage fluid culture. It was diagnosed as “pulmonary S. stercoralis complicated with N. otitidiscaviarum infection”. The patient was treated with a combination of sulfamethoxazole (0.96 g once, once per 6 h for 3 months), cefoperazone sodium and sulbactam sodium (3 g once, once per 12 h for 14 days), albendazole (400 mg twice daily for 7 days, continue 1 course after 1 month). After one week, sputum and fecal microscopic examination showed that most of the S. stercoralis died with a small amount survived. After 2 months follow-up, chest CT showed that the lesions were significantly reduced.

Key words: Strongyloides stercoralis, Nocardia otitidiscaviarum, Infection, Treatment