Abstract
Background: Intestinal pseudoobstruction is an uncommon complication of Strongyloides. We report an unusual case on intestinal pseudoobstrucion in an AIDS patient with disseminated strongyloides. Case: A 64-year-old Hispanic man with HIV/AIDS noncompliant with HAART presented with a 5-day history of abdominal pain, nausea, hematemesis and melena. On physical exam he had bibasilar crackles and melena. His labs were remarkable for anemia and CD4-count of 12. He was admitted to intensive care unit for a short period for upper endoscopy which showed clean based gastric ulcers in antrum. Sputum and stool studies were positive for strongyloides. There was no hyperinfection syndrome and all his blood cultures remained negative. He was treated empiric meropenem until he was transferred to regular floor and also recieved Ivermectin. Then he started having abdominal distention and altered mental status. KUB and CT scan abdomen showed evidence of abdominal distention with pseudoobstruction. He had a colonic decompression tube and received neostigmine and erythromycin. Discussion: There have been several case reports of pseudoobstuction caused by strongyloides outside the United States and several of them also underwent surgery. The intestinal pseudo-obstruction can be secondary to the metabolic imbalance due to the diarrhea and vomit; intestinal infection by itself can cause the paralytic ileus due to an inflammatory reaction of the larvae as they migrate through the bowel wall or could be related to the due to an extrinsic compression of the duodenum by the superior mesenteric neurovascular bundle.Figure: [1231]Figure: [1231]
Published Version
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