3062 Strongyloides stercoralis: A Rare Etiology of Infectious Colitis

Abstract

INTRODUCTION: Strongyloides colitis is a rare parasitic infection caused by the nematode (roundworm) Strongyloides Sterocalis. This infection is endemic to tropical and subtropical regions with poor sanitation, but it is also prevalent in rural regions of the United States. Here, we present a rare case of strongyloides colitis in a patient with human immunodeficiency virus. CASE DESCRIPTION/METHODS: The patient is a 40-year-old male with no significant past medical history who presented to the emergency department (ED) with progressive diffuse abdominal pain. The pain previously occurred with meals, but then became constant. Notable laboratory workup included a hemoglobin of 8.7 gm/dL and increased eosinophil count of 0.86 103/uL (ref range 0.04-0.54). The patient also tested positive for human immunodeficiency virus. A computed tomography scan of the abdomen showed a thickened colon from the level of the splenic flexure to the rectum indicating colitis as a possible diagnosis. Colonoscopy was then performed and showed diffuse severely ulcerated mucosa that oozed. In addition, there were prominent edematous folds with superimposed inflamed mucosa without the presence of discernible mass lesions. Intravenous antibiotics were started and there was symptomatic improvement leading to the patient's discharge. Three days post-discharge, the colonic biopsies returned showing parasitic larvae in the lamina propria of the colonic mucosa suggestive of Strongyloides species. The patient was contacted and stated he would return for follow-up to his doctor for treatment. DISCUSSION: Strongyloides colitis is an easily treated infection, however if untreated can have a high mortality rate. This is especially true for immunocompromised patients and those given immunosuppressive agents, such as those with inflammatory bowel disease (IBD). Considering this infection can present clinically and morphologically similar to IBD, it is important to differentiate the two before steroids and other immunosuppressive agents are administered. The feared complication of this infection is dissemination via autoinfection. Autoinfection is characterized by penetration of the intestinal mucosa by the larvae where they can then travel to the lungs causing pneumonia and acute respiratory distress syndrome. The larvae can also travel to various other organs causing multi-organ failure and death. This, however, can be avoided with proper diagnosis and successful treatment with Ivermectin or Albendazole.