Strongyloidiasis Of Duodenum Clinically Mimicking As Celiac Disease: A Case Report

Abstract

Abstract Casestudy Strongyloides stercoralis is classified as a roundworm or nematode. S. stercoralis is unique and different from other intestinal nematodes because of its ability to complete its life cycle within the host through an asexual auto infective cycle, allowing the infection to persist in the host indefinitely. It is usually asymptomatic can be symptomatic in immunocompromised individual leading to disseminated disease. Serology and stool microscopy are the investigations of choice. Though histopathology is the gold standard it is invasive procedure and has its own complication. strongyloidiasis is easily treatable with oral anthelminthic drugs. To date, only a limited number of cases has been published in our part of the world. Strongyloidiasis is often asymptomatic in immunocompetent individuals. We present the case of a 34-year old man from hilly region of Nepal with complaints of on and off abdominal pain since one and half year. Over the last week his symptoms worsened with bilious vomiting, nausea, abdominal pain, loss of appetite and weight loss. Patient was short statured with multiple pruritic lesions over skin. A clinical diagnosis of celiac disease was suspected clinically. Blood examination was performed shows Microcytic Hypochromic Anemia with mild increase in eosinophils. Stool examination and serology was performed it was negative. An endoscopic biopsy from duodenum was performed and histopathologic examination revealed gastrointestinal strongyloidiasis. Conclusion Helminthic infections can clinically mimic large number of non-neoplastic and neoplastic diseases like celiac sprue, IBD, GI malignancy etc. The present case highlights the importance of basic investigation like multiple stool examination in patient with GI symptoms before subjecting the patient to invasive procedures.