A 45-year-old woman, living in the urban area of Santiago de Cali (Valle del Cauca, Colombia), with low socioeconomic status, was employed as a sweetener on the street.
She had a history of chronic gastritis, severe malnutrition, four pregnancies with three live children, and one surgery for ligation of the trocars 16 years ago.
No history of diabetes mellitus, hypertension or smoking.
He had the habit of ingesting non-potable water.
The clinical picture began three months before admission, consisting of pain in the mesogastrium, asthenia, adynamia and edema in the lower limbs, progressing at two months with episodes of fetid diarrhea and loss of appetite.
In the last days he had episodes of hemoptoic cough.
Established a peripheral health center where S. stercolaris larvae were detected in the direct examination of stools with 0.9% physiologic saline solution and lubric acid.
Medical treatment was initiated with topical salicylate for two days (200 μg/kg/day) and albendazole (400 mg/day).
Laboratory tests showed albumin of 0.5 g/dL, negative HIV serology and positive HTLV I-II.
TSH was normal.
Seven days later the patient was referred to an extra-institutional Intensive Care Unit (ICU) due to respiratory distress.
The presumptive diagnoses were pulmonary embolism (PE), Lóeffler syndrome or bacterial pneumonia.
The patient was admitted to the ICU consciously, with signs of respiratory distress, tachycardic distress, with arterial oxygen saturation (SaO2) by pulse oximetry of 87%, with oxygen support (FiO2 50%).
Physical examination revealed fine rales, biphasic skin, abdomen with no signs of peritoneal irritation, grade III edema in the lower limbs, and presence of erythematous, pruritic, non-desquamative lesions in the thighs
On admission tests showed leukocytes of 26,200/mm3, hemoglobin 9.1 g/dL, neutrophils 86%, eosinophils 2%, C-reactive protein (CRP) 18 mg/dL, electrolytes and severe acid-base hypoxemia.
Chest X-ray showed mixed infiltrates predominantly alveolar diffuse distribution.
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The patient had progressive respiratory distress and required invasive mechanical ventilation without the need for high ventilatory parameters.
It also required vasoactive support with norepinephrine due to persistent hypotension.
Respiratory secretions remained constant during the clinical evolution, with a significant decrease
transfusion of red blood cells.
Suspicion of bacterial pneumonia was suspected when broad spectrum antibacterial coverage was initiated with piperacillin/ tape.
Subsequently, positive blood cultures and urine cultures for extended spectrum beta-openema Escherichia coli (BLEE) were reported, and treatment was switched to meropenem.
LAST was suspected in a sample of patients with pulmonary coccidioidosis requested fresh secretion from a sample of orotracheal secretions continued with S. stercoralis larvae. A new dose of ig/kg was administered twice daily (200 μg).
Pulmonary tuberculosis with negative serial smears was also ruled out.
Pathological diagnosis was nonspecific mild chronic colitis.
Immunological tests were not performed for diagnosis of colitis and colitis.
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The process of progressive decoupling of ventilatory support was performed, achieving extubation on the fifth day of invasive mechanical ventilation.
The patient completed a hospital stay of 12 days, during which she experienced episodes of dry cough.
In the clinical follow-up, the coproscopic study showed no evidence of intestinal obstruction, and the chest X-ray at 15 days showed a significant resolution of the pulmonary infiltrate.
It completed 10 days of anthelmintic treatment with albendazole.
The hemoglobin was 9.9 g/dL.
During the stay in the institution, the patient received physiotherapy management, which showed a favorable evolution of her cardiorespiratory condition and level of functionality.
