An Elusive Diagnosis of Strongyloides Infection Masquerading as Daptomycin-Induced Eosinophilic Pneumonitis.
Steven Y Zhou, Arber Sejdiu, Muhammad Abdullah et al.
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Case in brief
A middle-aged man with alcoholic cirrhosis developed peripheral eosinophilia, bilateral pulmonary nodules, migratory consolidative opacities, and pleural effusions while receiving daptomycin for polymicrobial bacteremia. The findings were initially attributed to daptomycin-induced eosinophilic pneumonitis, prompting discontinuation of the drug. Stool ova-and-parasite examination and bronchoalveolar lavage were negative, but Strongyloides serology was positive, establishing pulmonary strongyloidiasis. He improved clinically and radiographically after treatment with ivermectin and albendazole.
What made this case unusual
Pulmonary strongyloidiasis mimicked a recognized daptomycin adverse effect, while both stool examination and bronchoalveolar lavage were negative; serology established the diagnosis.
Diagnostic / clinical pearl
In a patient receiving daptomycin who has eosinophilia and pulmonary infiltrates, consider Strongyloides rather than attributing the findings solely to drug toxicity; negative stool and lavage tests do not exclude infection, and serology may be diagnostic.
Why it matters
The report highlights the risk of missing Strongyloides, which can progress to high-mortality hyperinfection syndrome if untreated.