A 56‐Year‐Old Woman with Rash, Paralytic Ileus, and Massive Gastrointestinal Bleeding

Abstract

Diagnosis: Strongyloides stercoralis hyperinfection syndrome in a patient with human T lymphotropic virus type 1 (HTLV 1) infection. The duodenal sample obtained through a nasogastric tube showed multiple filariform larvae of Strongyloides stercoralis (figure 1; figure 2). Enzyme-linked immunosorbent assay (ELISA) test for toxins of Clostridium difficile had negative results, and stool cultures for bacteria showed no growth. Cultures of blood samples obtained during the abdominal catastrophe were positive for Escherichia coli. Strongyloidiasis is a parasitic disease that is caused by the soil-transmitted nematode 5. stercoralis, which is estimated to affect almost 300 million people worldwide. Once infected, humans may harbor the parasite for decades. Most of the in fections due to S. stercoralis are asymptomatic or mildly symp tomatic. However, in the presence of immunosuppressive con ditions (such as high-dose steroid use, use of cytotoxic drugs, malignancies, human immunodeficiency virus infection, mal nutrition, and more recently, HTLV-1 infection), an autoin fective cycle may ensue that amplifies the infection and leads to the hyperinfection syndrome [1], Multiple erosions in the colonic mucosa result from the migration of the filariform lar va across the intestinal wall and may induce massive bleed ing, which is associated with significant mortality [2]. The family history of T cell leukemia lymphoma in this patient raised the suspicion of HTLV-1 infection, which was confirmed by means of an ELISA and Western blot tests. The patient recalled that her sister had also been infected with HTLV-1. Further evaluation of her relatives revealed that 2 of