Acute respiratory failure due to strongyloidiasis in polymyositis.

Strongyloides stercoralis is an intestinal nematode which infects large numbers of the population of tropical and subtropical geographic zones. Autoinfection permits the parasite to persist in asymptomatic hosts for years after they leave the tropics. Occasionally, in immunosuppressed patients, massive pulmonary or systemic invasion occurs. We report such an event in a corticosteroid treated patient with severe polymyositis. The life cycle of this parasite and the potential for overwhelming infestation are reviewed. As immunosuppressive therapy becomes more routine in rheumatic diseases, the rheumatologist should be aware of this sinister opportunistic pathogen.