Abstract
Strongyloides stercoralis is an intestinal nematode that commonly causes chronic and asymptomatic infection, but in some situations, especially in cases of immunosuppression, infection by this parasite can manifest with extreme severity and high mortality. Hyperinfection syndrome and disseminated strongyloidiasis are two serious, life-threatening presentations associated with immunosuppression. We report the case of a 69 year-old male with diffuse abdominal pain, intermittent diarrhea, and fever. Stool analysis for parasitic infection was negative. Upper gastrointestinal endoscopy with duodenal biopsy revealed ulcerative duodenitis due to strongyloidiasis, showing the presence of several larvae in lymph and intraglandular ducts. Definitive diagnosis was established as S. stercoralis hyperinfection syndrome.
Highlights
Strongyloides stercoralis is an intestinal nematode that commonly causes chronic or asymptomatic infection, but in some situations, especially in immunosuppressed patients, infection by this parasite can manifest with extreme severity and high mortality
This paper aims to report a case of duodenal strongyloidiasis that was associated with malabsorption syndrome and evolved to hyperinfection
Strongyloidiasis is an infection caused by two species of the strongyloides nematode, the human pathogen of major clinical importance being the Strongyloides stercoralis[1,2,3]
Summary
A 69 year-old Caucasian male, agronomist, sought the emergency department complaining of diffuse abdominal pain, intermittent watery diarrhea, and fever. At admission he remained with diffuse abdominal pain, associated with nausea, vomiting, and loss of appetite. Vesicular murmur was decreased at the right hemithorax, and abdominal exam revealed diffuse pain to palpation, with no other signs of peritoneal irritation. Chest radiograph showed an opacity with irregular borders in the lower third of the right lung. The histopathological report was consistent with ulcerative duodenitis due to strongyloidiasis (figure 2), showing the presence of larvae in several lymph and intraglandular crypts. After histological diagnosis was established, treatment with albendazole and ivermectin was given for 14 days, with significant improvement in symptoms. Additional treatment with imipenem was provided for 14 days, with satisfactory recovery
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