Intestinal Strongyliodes stercoralis Infection Mimicking Inflammatory Bowel Disease: A Case Report

Abstract

A 47 year-old prisoner of Hispanic descent, with no significant past medical history, presented to our clinic with the long standing complaint of progressive abdominal pain. The patient reported left upper quadrant abdominal pain for many years which was progressively worsening. He also reported frequent bloody stools, but denied other gastrointestinal symptoms such as nausea, vomiting, diarrhea or significant weight loss. A colonoscopy was performed for further evaluation and was normal with random colonic biopsies showing focal crypt distortion with slight expansion of the lamina propria by lymphoplasmacytic and eosinophilic infiltrates. A computed tomography (CT) enterography scan was subsequently performed which showed mild thickening and mucosal enhancement of a short segment of proximal jejunum (Figure 1). A small bowel enteroscopy was thus performed, revealing severe diffuse congestion, nodularity, friability and ulcerations of the distal duodenum and proximal jejunum (Figure 2). These mucosal changes caused mild stenosis in some portions of the involved small bowel. Biopsies taken from the area showed active inflammation with numerous parasitic organisms morphologically consistent with strongyloides stercoralis (Figure 3). The patient was subsequently treated with ivermectin with improvement in his symptoms.Figure 1Figure 2Figure 3This case demonstrated a unique finding of gastrointestinal infection from strongyloides stercoralis which is rarely seen in the United States.1 This patient's findings on CT and certainly on enteroscopy were initially suggestive of an underlying diagnosis of Crohn's disease with small bowel involvement. This emphasizes the fact that parasitic infections like strongyloides can often mimic inflammatory bowel disease. Furthermore, this patient had non-specific bowel complaints for many years further highlighting the fact that these parasitic infections can persist in a chronic fashion.