Systemic strongyloidiasis in a human T-lymphotropic virus type-1-positive man presenting as chronic pancreatitis with a pancreatico-biliary stricture

Abstract

Objective: To report an unusual case of systemic strongyloidiasis and to highlight the close association of this condition with human T-lymphotropic virus type 1 (HTLV-1 ) infection in patients from endemic areas. Patient: A 62-year-old West Indian man, resident in the United Kingdom since 1965 and consuming 200 units of alcohol per week, presented with symptoms of chronic pancreatitis and evidence of malabsorption. He had a tight pancreatico-biliary stricture on endoscopie retrograde cholangio-pancreatography. Pancreatic duct brushings and duodenal and rectal biopsies confirmed invasive strongyloidiasis. Interventions: Pancreatic duct stenting provided immediate relief of post-prandial pain. Combination anti-helminthic therapy with thiabendazole and albendazole rapidly improved the malabsorption. Outcome: The patient remains well and symptom-free 2 years later, despite continued alcohol abuse. Conclusion: Systemic strongyloidiasis should be included in the differential diagnosis of patients originating from endemic areas who present with malabsorption. Their HTLV-1 status should also be established because of the close association between the two conditions.