1639 Chronic Diarrhea Due to Pancolitis Caused by Trichuris trichiura

Abstract

INTRODUCTION: Indonesia as one of the largest tropical countries in the world, shared the particularly high burden cases of parasitic colitis especially due to worm infections; Therefore patient with chronic diarrhea in tropical country should be evaluated for parasitic infections such as Trichiasis. CASE DESCRIPTION/METHODS: 22-year-old woman presented with prolonged diarrhea with mucus and no blood since one month ago. She had two to four times bowel movements once a day. She also complained for having recurrent diffuse periumbilical pain and nausea every day. She also reported for having weight loss of 3 kg. She had no remarkable past medical history. She admitted for having poor hygiene lifestyle and using non purified ground water as drinking water. She previously had visited nearest hospital for consultation, the blood test showed hemoglobin of 12.8 g/dl, white blood cell of 28,000/mL; stool analysis showed positive microscopic erythrocyte and leukocyte without worm eggs or other parasites. Other laboratory value was normal. She was admitted and treated with Levofloxacin, attaplugite, and probiotic. After five days of hospitalization, no improvement was seen, therefore she was referred to our hospital endoscopy unit for colonoscopy. Colonoscopy examination showed inflammation of the entire colon with erosion and ulceration, also multiple Trichuris trichiura were found. She was treated with mebendazole. She had clinical improvement and re-colonoscopy was done after two weeks. Re-colonoscopy examination showed no inflammation and no worms were found. DISCUSSION: Patients with Chronic diarrhea in tropical countries should always be evaluated for parasitic infections. Stool examination and colonoscopy may be helpful to establish the diagnosis. Trichuris trichiura infections may manifest as asymptomatic infection or chronic diarrhea or dysentery which may mimic inflammatory bowel disease.