A 45-year-old male of African origin living in Spain since 1985 was admitted for exertional dyspnea, dry cough, diarrhea and constitutional syndrome of 1 month of evolution.
A history of HIV infection stage C3 known from about 13 years before and controlled up to 1 year before the present admission, in which antiretroviral treatment (z abandoned disease, 3TC and indinavir) and controls for HIV infection stood out
During the last year she required 2 hospital admissions for diarrhea, being diagnosed with isosporiasis on both occasions and receiving treatment with cotrimoxazole.
In a parasitological study carried out after the second admission, the presence of stercoralis larvae in feces was evidenced.
Despite an active search for the patient, it could not be treated for not attending control.
On examination performed on admission, a cachectic patient with axillary temperature of 38.2oC, RR 25x, TA 121/61 stood out.
Cardiorespiratory auscultation was anodyne and abdominal examination was normal.
Blood tests revealed: 4,310 white blood cells (3,060 neutrophils, 300 lymphocytes, 780 monocytes), to 22%, Hbukocytes, Hbukdl, ASTuk03 mg/dl, platelets ≥ 1,67 mmol/l
GAB: pH 7.5, HCO3 24.2, pO2 55 mmHg, pCO2 30.9 mmHg, SO2 87%.
The chest X-ray showed a bilateral interstitial pattern.
Blood cultures were performed and antibiotic treatment with cefepime and cotrimoxazole was initiated.
A transfusion of 2 concentrates was performed.
The patient remained afflicted with persistent tachypnea, tachypnea and hypotension, and the constitutional syndrome persisted.
Blood cultures were positive for 3rd generation cephalosporin-sensitive Escherichia coli.
On the sixth day, oropharyngeal candidiasis was found and treated with fluconazole.
At this time, the patient presented hemoptoic expectoration.
A new chest X-ray showed persistent diffuse interstitial lung pattern, and a high resolution chest CT showed diffuse parenchymal involvement with ground glass pattern and areas of parenchymal consolidation.
A sputum bacteriological study was requested, and both Gram stain and Ziehl Neel staining showed abundant larvaesenyloides stercoralis.
Treatment with albendazole was initiated waiting to be able to treat the disease (requested as a foreign medication) but the patient died, finally presenting progressive respiratory failure and weakness and anorexia more and more intense 24 hours later.
The diagnosis of hyperinfection syndrome due to candidiasis stercoralis bacteraemia, Escherichia coli and oropharyngeal infection in HIV patient stage C3 was established.
