A 58-year-old male farmer, local resident, who had been diagnosed as MPA, received intravenous cyclophosphamide (500mg) semimonthly and oral prednisolone (40mg/d) for two months and discharged after improvement, was readmitted due to hyperpyrexia, ventosity, hypodynamia and inappetence for a week. Initial vital signs at his second hospitalization were temperature 38.0  C, blood pressure 104/66 mmHg, heart rate 102 beats/min, respiration rate 20/min, oxygen saturation 95 %.There was no conspicuous abnormality in general physical examination. Blood routine results were as follows: white blood cells 6.7*10^9/L, Neutrophils 79 %, eosinophils 3%, hemoglobin 70g/l and normal platelets. Hypoproteinemia (22.4g/l), hyponatremia (129mmol/l) and elevated C -reactive protein (43.2mg/l) were observed. Liver function was almost normal except for transaminase elevated slightly. Kidney function, HIV antibody, arterial blood gas analysis, rheumatism, tuberculosis and virus related indicators as well as cranial magnetic resonance imaging were all basically normal. Computed tomography scan revealed high density patchy shadow in right superior lung lobe, a nodular cavity in left lower lung lobe and focal small intestine wall thickening. (Fig. 1, Fig. 2).
After intravenous of Sulperazone for three days, the farmer's body temperature dropped to normal. However, his condition didn't improved. Instead, he appeared abdominal pain, anus without defecating, dyspnea, cough and sputum. Expectant treatment resulted in defecation and pain relief. Meanwhile, bedside bronchoscope was performed. A mass of S. stercoralis, nocardia and citrobacter freundii (CF) were found both in sputum and bronchoalveolar lavage fluid (BALF) on day 5 of hospitalization. (Fig. 3, Fig. 4). Hence, we adjusted the therapeutic regimen to Albendazole (400mg/d), Tienam (0.5g, ivgtt, q8h), and Cotrimoxazole (0.48,po.tid). Unfortunately, two days later, the patient quickly had a fever again, developed severe septic shock, obstinate respiratory failure, and finally died.