Case Study An Extensive History: Always Useful

The patient is a 64-year-old male resident of a mental institution with a chief complaint of cough and rash. He was a Vietnam veteran with a history of non-Hodgkin's lymphoma treated with combination chemotherapy containing prednisone. Two months later he developed a progressive cough, dyspnea, midepigastric pain, diarrhea, and what he describes as an itchy rash on the lower abdominal wall. The patient's physical examination revealed a thin man in mild distress with a temperature of 100°F (37.8°C), blood pressure 124/70 mmHg, pulse 120, and respiratory rate 25 per minute. Rales were heard throughout his lung fields. His abdomen was soft and flat, with hypoactive bowel sounds. There was marked tenderness without rebound noted on palpation of the epigastric area, with no masses. His skin examination revealed a migratory serpiginous urticarial rash distributed over the lower abdomen, lower trunk, and buttocks (larva currens). Examination of the peripheral blood showed a white count of 16,190/mm3 (normal, 4,000-12,000/mm3) and eosinophils 66% (markedly elevated). His chest radiograph showed diffuse pulmonary infiltrates. A transbronchial lung biopsy showed eosinophilic granulomatous inflammation of the bronchial epithelium. Bronchoalveolar lavage revealed S. stercoralis filariform larvae. Microscopic examination of the stool revealed rhabditiform larvae of S. stercoralis. Based on the knowledge of S. stercoralis hyperinfection syndrome, which agent or agents would be a logical choice for treatment of this life-threatening disease?

10 Ways To Fight Off Cancer

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