Strongyloidiasis gastritis and colitis in a patient with leprosy

A 45-year-old male patient from the Central West region of Brazil was treated for lepromatous (or virchowian hanseniasis) multibacillary leprosy 7 years ago with dapsone, clofazimine, and rifampicin for 2 years. Intermittent administration of thalidomide (300 mg/day) and prednisone (60 mg/day) for 2 years was required for the episodes of erythema nodosum. Eighteen months ago, leprosy treatment was restarted with ofloxacin, clofazimine, and rifampicin, along with thalidomide and prednisone. The patient was hospitalized with a chief complaint of abdominal pain for 2 months and weight loss of 15 kg. Upper gastrointestinal endoscopy and colonoscopy performed during the clinical investigation revealed moderate gastritis, duodenitis, and mild pancolitis. Anatomopathological analysis showed the presence of Strongyloides stercoralis in the gastric (Figure 1), duodenal (Figure 2), and colonic (Figure 3) fragments. The patient’s condition improved clinically after initial treatment with ivermectin and later with thiabendazole. The patient was discharged with outpatient follow-up.

FIGURE 1:
Pathological examination of a gastric tissue fragment showing the mucosa with a histologically normal fundus, parasitic structures compatible with Strongyloides stercoralis, and absence of neoplasia or Helicobacter pylori.

FIGURE 2:
Pathological examination of the duodenum fragment showing colonic pattern mucosa with discrete colitis, parasitic structures compatible with Strongyloides stercoralis, and absence of neoplasm.

FIGURE 3:
Pathological examination of ascending colon fragment showing colonic pattern mucosa with discrete colitis, presence of eosinophils and parasitic structures compatible with Strongyloides stercoralis, and absence of neoplasm.

Disseminated strongyloidiasis in patients with intermittent leprosy reactions and chronic steroid use should be considered^1,2.

ACKNOWLEDGMENTS

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

REFERENCES

• ¹
  Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F , Van Den Ende J, et al. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis. 2013;13:78. Available from: https://doi.org/10.1186/1471-2334-13-78
  » https://doi.org/10.1186/1471-2334-13-78
• ²
  Fairley JK, Ferreira JA, de Oliveira ALG, de Filippis T, Grossi MAF, Chaves LP, et al. The burden of helminth coinfections and micronutrient deficiencies in patients with and without leprosy reactions: A pilot study in Minas Gerais, Brazil. Am J Trop Med Hyg. 2019;101(5):1058-65. Available from: https://doi.org/10.4269/ajtmh.18-0502
  » https://doi.org/10.4269/ajtmh.18-0502

• Financial Support: There was no financial support from agencies or institutions.

Publication Dates

• Publication in this collection
  19 Sept 2022
• Date of issue
  2022

History

• Received
  12 Apr 2022
• Accepted
  05 July 2022