Abstract
Strongyloidiasis is a helminthic disease which affects millions around the world resulting in a significant burden in certain high risk groups. It is rarely reported in the Lebanese population probably due to the low index of suspicion in common practice. We are reporting a case of strongyloidiasis that was found in an elderly patient presenting initially with dyspnea followed by skin rash, protein loosing enteropathy, diarrhea, and abdominal pain while on corticosteroid therapy. The diagnosis was suspected based on clinical presentation in addition to peripheral eosinophilia. We will also describe the upper and lower endoscopic aspects of the disease, as well as histologic findings on duodenal and colonic biopsies.
Highlights
Intestinal nematode infections are frequently encountered worldwide with a net predominance in the hot and humid tropical and subtropical areas
His medical history was significant for hypertension controlled on Bisoprolol and Irbesartan, dyslipidemia treated with Atorvastatin, and a transient cerebral ischemic attack 5 months prior to presentation for which he was put on aspirin and clopidogrel. He was incidentally found to have peripheral eosinophilia of 1050 eos/mm3 (13.7% of total leukocytes) without going into further investigations. He had a brother diagnosed with NonHodgkin Lymphoma who died few months earlier after a prolonged hospitalization for unexplained dyspnea, attributed later on to a Strongyloides stercoralis infection detected in his bronchoalveolar lavage only one day before his death
Twenty-four-hour urine collection revealed only 180 mg of proteins. In view of his unexplained eosinophilia associated with diarrhea and abdominal pain, together with his history of dyspnea and skin rash that flared up while on steroids and his brother’s history of strongyloidiasis, we strongly suspected an underlying strongyloides infection
Summary
Intestinal nematode infections are frequently encountered worldwide with a net predominance in the hot and humid tropical and subtropical areas. Strongyloidiasis is among the most important helminthic infections affecting humans and it may manifest clinically as mild or asymptomatic disease persisting for decades, and it can have life-threatening manifestations. In Lebanon, it is an unusual infection and is not frequently reported in the literature. We are hereby reporting a case of strongyloidiasis in a Lebanese patient presenting in a picture of diarrhea and refractory hypoalbuminemia after two months’ history of unexplained dyspnea and skin rash
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