Estrongiloidiose gastrointestinal grave

IMAGES IN INFECTIOUS DISEASES

Severe gastrointestinal strongyloidiasis

José Roberto Lambertucci^I; Mateus Rodrigues Westin^I; Alfredo José Afonso Barbosa^II

^IServiço de Doenças Infecciosas da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG

^IIDepartamento de Anatomia Patológica da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG

^{Correspondence}

A 26-year-old man was admitted to hospital complaining of colic abdominal pain, nausea, vomiting and diarrhea, which started 9 days before. He has been receiving prednisone (80mg/day) for the last 2 months for the treatment of schistosomal myeloradiculopathy and omeprazole for gastric protection. He was also treated for strongyloidiasis with ivermectin (12mg, single dose) before starting prednisone. His clinical condition deteriorated rapidly after admission, with severe vomiting, dehydration, hyponatremia (115mEq/L), hypoalbuminemia (0.9g/dl) and paralytic ileus. A urinary tract infection, caused by Escherichia coli, was diagnosed and treated with ciprofloxacin. Fifteen days after admission, parenteral nutrition was initiated. A gastrointestinal contrasted radiograph was performed and it showed a dilated stomach and stricture of the lumen of duodenum and jejunum (Figure A – arrow). Upper endoscopy revealed a moderate enanthematous gastritis and in the antrum and duodenum it was described a friable mucosa with bleeding, edema and elevated whitish areas (Figure B). Biopsies of the esophagus, stomach and duodenum were obtained and submitted to histological examination. In the stomach a great number of larvae of Strongyloides were identified (Figure C – the arrow points to a larva of Strongyloides), and they were surrounded by inflammatory cells and eosinophils. The patient was treated with ivermectin (12mg, single dose) followed by albendazole (400mg/day) for 10 days and improved over the following 8 days. Two months later, at the outpatient clinic, he was feeling well. Strongyloides larvae were still found in his stools. He received albendazole (400/day) again for 30 days and remains asymptomatic.

REFERENCES

1. Benhur Junior A, Serufo JC, Lambertucci JR. Pulmonary strongyloidiasis. Revista da Sociedade Brasileira de Medicina Tropical 37: 359-360, 2004.

2. Lambertucci JR, Leão FC, Barbosa AJA. Gastric strongyloidiasis and infection by the human T cell lymphotropic virus type 1 (HTLV-1). Revista da Sociedade Brasileira de Medicina Tropical 36: 541-542, 2003.

3. Porto MAF, Muniz A, Oliveira Júnior J, Carvalho EM. Implicações clínicas e imunológicas da associação entre o HTLV-1 e a estrongiloidíase. Revista da Sociedade Brasileira de Medicina Tropical 35: 641-649, 2002.

Recebido para publicação em 7/4/2005

Aceito em 3/5/2005

Datas de Publicação

• Publicação nesta coleção
  08 Set 2005
• Data do Fascículo
  Ago 2005