Disseminated gastrointestinal strongyloidiasisTorre A. Estrongiloidiasis gastrointestinal...

2
Revista de Gastroenterología de México. 2015;80(4):280---281 www.elsevier.es/rgmx REVISTA DE GASTROENTEROLOGIA DE MEXICO ´ ´ CLINICAL IMAGE IN GASTROENTEROLOGY Disseminated gastrointestinal strongyloidiasis Estrongiloidiasis gastrointestinal diseminada J.M. Antolinez-Motta b , F. Chablé-Montero a , A. Torre b,a Departamento de Patología, Fundación Clínica Médica Sur, Mexico City, Mexico b Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico Strongyloides stercoralis is a nematode capable of produc- ing an asymptomatic infection; it is endemic in tropical and subtropical regions. Immunocompromised patients are par- ticularly susceptible. It is considered a dangerous condition in this population, especially when disseminated disease is associated with hyperinfection. A 72-year-old man had a history of previously treated chronic myeloid leukemia, now in remission for a period of 10 years. He was admit- ted to the hospital with a 3-month history of diarrhea, no evidence of bloody stools or parasites, colicky-type abdominal pain, persistent fatigue, and weight loss. Phys- ical examination revealed a slightly distended abdomen and no other abnormalities. Laboratory work-up showed a leukocyte count of 31,900 L, eosinophils 15,950 L (50%), and neutrophils 5,724 L; the other tests were within the normal range. Upper and lower endoscopy was performed and revealed mild duodenal atrophy and colonic erythema. Endoscopic biopsy specimens from the duodenal and colonic mucosa revealed numerous rhabditiform larvae, and intense eosinophilic-rich acute and chronic inflammatory infiltrate. The diagnosis of duodenal and colonic strongyloidiasis was established (Figs. 1-3). Please cite this article as: Antolinez-Motta JM, Chablé-Montero F, Torre A. Estrongiloidiasis gastrointestinal diseminada. Revista de Gastroenterología de México. 2015;80:280---281. Corresponding author. Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15 Col. Sección XVI Del. Tlalpan México D.F. 14000, Tel.: +52 55 5487 0900, Ext.: 2711. E-mail address: [email protected] (A. Torre). Figure 1 Gastroduodenal endoscopy showing white villi in the second portion of the duodenum. 2255-534X/© 2015 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Elsevier - Publisher Connector

Transcript of Disseminated gastrointestinal strongyloidiasisTorre A. Estrongiloidiasis gastrointestinal...

Page 1: Disseminated gastrointestinal strongyloidiasisTorre A. Estrongiloidiasis gastrointestinal diseminada. Revista de Gastroenterología de México. 2015;80:280---281. ∗ Corresponding

R

C

D

E

J

a

b

SistiiantnaialanaEmeTe

FG

IVT

2t

by COREView metadata

her Connector

evista de Gastroenterología de México. 2015;80(4):280---281

www.elsevier.es/rgmx

REVISTA DEGASTROENTEROLOGIA

DE MEXICO´

´

LINICAL IMAGE IN GASTROENTEROLOGY

isseminated gastrointestinal strongyloidiasis�

strongiloidiasis gastrointestinal diseminada

.M. Antolinez-Mottab, F. Chablé-Monteroa, A. Torreb,∗

Departamento de Patología, Fundación Clínica Médica Sur, Mexico City, Mexico

brought to you, citation and similar papers at core.ac.uk

provided by Elsevier - Publis

Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Figure 1 Gastroduodenal endoscopy showing white villi in thesecond portion of the duodenum.

trongyloides stercoralis is a nematode capable of produc-ng an asymptomatic infection; it is endemic in tropical andubtropical regions. Immunocompromised patients are par-icularly susceptible. It is considered a dangerous conditionn this population, especially when disseminated diseases associated with hyperinfection. A 72-year-old man had

history of previously treated chronic myeloid leukemia,ow in remission for a period of 10 years. He was admit-ed to the hospital with a 3-month history of diarrhea,o evidence of bloody stools or parasites, colicky-typebdominal pain, persistent fatigue, and weight loss. Phys-cal examination revealed a slightly distended abdomennd no other abnormalities. Laboratory work-up showed aeukocyte count of 31,900 �L, eosinophils 15,950 �L (50%),nd neutrophils 5,724 �L; the other tests were within theormal range. Upper and lower endoscopy was performednd revealed mild duodenal atrophy and colonic erythema.ndoscopic biopsy specimens from the duodenal and colonicucosa revealed numerous rhabditiform larvae, and intense

osinophilic-rich acute and chronic inflammatory infiltrate.he diagnosis of duodenal and colonic strongyloidiasis wasstablished (Figs. 1-3).

� Please cite this article as: Antolinez-Motta JM, Chablé-Montero, Torre A. Estrongiloidiasis gastrointestinal diseminada. Revista deastroenterología de México. 2015;80:280---281.∗ Corresponding author. Departamento de Gastroenterología,

nstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán,asco de Quiroga 15 Col. Sección XVI Del. Tlalpan México D.F. 14000,el.: +52 55 5487 0900, Ext.: 2711.

E-mail address: [email protected] (A. Torre).

255-534X/© 2015 Asociación Mexicana de Gastroenterología. Publishedhe CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-n

by Masson Doyma México S.A. This is an open access article underd/4.0/).

Page 2: Disseminated gastrointestinal strongyloidiasisTorre A. Estrongiloidiasis gastrointestinal diseminada. Revista de Gastroenterología de México. 2015;80:280---281. ∗ Corresponding

Disseminated gastrointestinal strongyloidiasis

Figure 2 Duodenal mucosa with mild atrophy. The cryptsshow numerous rhabditiform larvae of Strongyloides sterco-ralis. The lamina propria shows an intense eosinophilic-richacute and chronic inflammatory infiltrate (H&E, x100).

Figure 3 Higher magnification of the duodenal mucosa shownin Figure 2. The larvae are in the lumen of the crypts and

E

Ptf

Dft

Rojp

F

N

Conflict of interest

The authors declare that there is no conflict of interest.

produce reparative changes of the intestinal epithelium. The

inflammatory response with abundant eosinophils is clearly seenin the lamina propria (H&E, x300).

281

thical responsibilities

rotection of persons and animals. The authors declarehat no experiments were performed on humans or animalsor this study.

ata confidentiality. The authors declare that they haveollowed the protocols of their work center in relation tohe publication of patient data.

ight to privacy and informed consent. The authors havebtained the informed consent of the patients and/or sub-ects referred to in the article. This document is in theossession of the corresponding author.

inancial disclosure

o financial support was received in relation to this article.