BEYOND ALLERGENS: A PARASITIC TWIST IN ASTHMA EXACERBATION – CASE REPORT

Authors: Dr Aishwarya Alavandar, Dr.Koushik MuthuRaja Mathivanan

DOI: 10.18231/j.ijmmtd.12012.1761566473

Keywords: Strongyloidiasis, asthma, acute exacerbation, ivermectin, parasitic infection

Abstract: Case Presentation: A 34-year-old female with a known history of bronchial asthma on regular inhaled therapy presented with acute worsening of respiratory symptoms. She reported progressive cough, wheezing, and dyspnoea over the preceding week. There was no history of recent travel, change in environment, or exposure to new allergens. On examination, she was hemodynamically stable, with an oxygen saturation of 92% on room air. Auscultation revealed bilateral, diffuse wheezing. Laboratory investigations showed normal total leukocyte counts; however, serum total IgE and absolute eosinophil counts were elevated. A chest radiograph demonstrated increased bronchovascular markings. Despite administration of intravenous corticosteroids, the patient's symptoms persisted without significant improvement. To further investigate a potential infective aetiology, high-resolution computed tomography (HRCT) of the chest was performed. The scan revealed bilateral lower lobe ground-glass opacities with mosaic attenuation, raising suspicion of small airway involvement or infection. Bronchoscopy with bronchoalveolar lavage (BAL) was subsequently undertaken to evaluate for intraluminal obstruction and to identify any occult infectious agents. Microscopic examination of the BAL fluid revealed motile larvae with morphological features consistent with Strongyloides stercoralis. The diagnosis was confirmed by polymerase chain reaction (PCR) testing. The patient was initiated on oral ivermectin therapy, which resulted in marked clinical improvement within a few days. She was discharged in stable condition with continued asthma management using inhaled corticosteroids and bronchodilators