SHM Converge Scientific Abstract ePoster Gallery-Helminth Infection in a Patient Taking Dupilumab: A Case Report

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A 63-year-old man with atopy on dupilumab presented with one week of flu-like symptoms, rigors, right upper quadrant pain, fever, hypoxia, and sepsis. Imaging revealed hepatic abscesses, and blood plus abscess cultures grew Streptococcus intermedius. He was treated with vancomycin, piperacillin-tazobactam, and JP drainage.<br /><br />On hospital day 3, he developed acute tachycardia, tachypnea, diffuse wheezing, and worsening hypoxia requiring BiPAP. Chest X-ray showed diffuse bilateral airspace opacities, but these resolved rapidly within 48 hours, consistent with Löffler syndrome from transient pulmonary migration of helminth larvae. By day 5 he no longer needed oxygen and repeat chest imaging was normal.<br /><br />At discharge, a worm was found in one of the JP drains and was identified as consistent with Ascaris lumbricoides. He was treated with albendazole at discharge and again 8 weeks later, with full recovery.<br /><br />The authors concluded that this was disseminated ascariasis likely facilitated by dupilumab-related immune modulation. They proposed that Ascaris migration through the portal system caused the liver abscesses and that pulmonary larval migration explained the transient respiratory syndrome. The case also suggested possible association with secondary Streptococcus intermedius bacteremia, which may have been seeded during parasite migration. The report emphasizes considering helminth infection in atypical presentations, especially in patients receiving dupilumab, and calls for further research on how dupilumab affects host responses to parasitic infections.

Asset Subtitle

Mary K. VanHooser

Meta Tag

Author List Mary K. VanHooser, Ronald Brownfield

Category Clinical Vignettes

Concept Disseminated Ascariasis

Concept Ascaris lumbricoides

Concept Atypical Hepatic Abscess

Concept Löffler Syndrome

Concept Streptococcus intermedius

Distinguished Non-Finalist

Presenter Organization Holzer Medical Center

Presenting Author Mary K. VanHooser

Track Adult

Keywords

Ascaris lumbricoides

disseminated ascariasis

hepatic abscess

Streptococcus intermedius

dupilumab

Löffler syndrome

helminth infection

pulmonary migration

albendazole

sepsis

Disseminated Ascariasis

Ascaris lumbricoides

Atypical Hepatic Abscess

Löffler Syndrome

Streptococcus intermedius