Microsporidiosis: An Unusual Endoscopic Finding

Abstract

A72-year-old man with hypertension, diabetes, and a recent kidney transplant who was taking mycophenolate mofetil, tacrolimus, and prednisone was admitted to the hospital with complaints of nausea, vomiting, and diarrhea. Patient started having 5–6 profuse watery bowel movements 4 days before admission. He was having persistent nausea and occasional vomiting that were affecting his oral intake of food. His examination was suggestive of decreased skin turgor and dry oral mucosa but was otherwise unremarkable. His lab results on admission were significant for blood urea nitrogen 46mg/dL and creatinine 3.45mg/dL. Initial stool studies were negative, including Clostridium difficile toxin polymerase chain reaction. After appropriate resuscitation, the patient underwent esophagogastroduodenoscopy and colonoscopy for his persistent symptoms of nausea, vomiting, and diarrhea. Esophagogastroduodenoscopy interestingly revealed innumerable serpiginous ulcers in the duodenum. The ulcers were over the folds of duodenum and had necrotic-appearing centers (Figure A). Cold forceps biopsies were taken. There was evidence of duodenitis in the duodenal bulb. Colonoscopy revealed normal colonic mucosa, and randombiopsieswere taken. Onpathologic examination of duodenal and colonic biopsies, organisms compatiblewith microsporidia-type species were present (Figures B–D). Microsporidia spores can be seen within enterocytes (arrows) and within lamina propria macrophages (asterisks). Ultrastructurally, electron microscopy performed at Centers for Disease Control and Prevention showed scattered spores of microsporidia-type species, most readily within lamina propria, and macrophages (Figures E and F).