Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia
Strongyloides stercoralis is an intestinal nematode that colonizes and reproduces in the upper small intestinal mucosa. Infection in immunocompetent hosts is self-limited but in immunocompromised patients it can be complicated and cause hyperinfection. We present a 60-year-old female who was admitte...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2021-02-01
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| Series: | GE: Portuguese Journal of Gastroenterology |
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| Online Access: | https://www.karger.com/Article/FullText/514015 |
| _version_ | 1818428670824415232 |
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| author | María del Mar Díaz Alcázar Adelina García Robles Javier Luis López Hidalgo Dolores Quintero Fuentes Alicia Martín-Lagos Maldonado |
| author_facet | María del Mar Díaz Alcázar Adelina García Robles Javier Luis López Hidalgo Dolores Quintero Fuentes Alicia Martín-Lagos Maldonado |
| author_sort | María del Mar Díaz Alcázar |
| collection | DOAJ |
| description | Strongyloides stercoralis is an intestinal nematode that colonizes and reproduces in the upper small intestinal mucosa. Infection in immunocompetent hosts is self-limited but in immunocompromised patients it can be complicated and cause hyperinfection. We present a 60-year-old female who was admitted due to an exacerbation of acquired thrombotic thrombocytopenic purpura requiring high doses of corticosteroids. The patient began to experience persistent pyrosis, nausea, vomiting, and oral intolerance. She was diagnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Upper endoscopy was performed and showed esophageal, gastric, and duodenal mucosa with edema and erythema. Moreover, there were superficial erosions and thickened folds in duodenum. Gastric and duodenal biopsies were taken. Abdominal computed tomography and magnetic enteroresonance displayed duodenal dilation and inflammatory changes. The histological study of biopsies showed colonization by S. stercolaris in the antrum and duodenum. S. stercolaris is a human parasite that is endemic in tropical, subtropical, and temperate regions. Its lifecycle is complex because it completes its entire cycle within the human host; it penetrates the skin, migrates to the lungs, and reach the gastrointestinal tract. The most affected site is the duodenum and upper jejunum. The lifecycle includes autoinfection through the intestinal mucosa or perianal skin, especially in immunocompromised hosts. Immunossuppression can lead to hyperinfection syndrome and disseminated disease. However, involvement of the stomach has relatively rarely been reported. SIADH has been related to systemic hyperinfection, although the mechanism is not clear. The relatively nonspecific clinical and imaging features and the low sensitivity of routine parasite tests make the diagnosis challenging and delayed. |
| first_indexed | 2024-12-14T15:05:19Z |
| format | Article |
| id | doaj.art-6fbd24c761ec4819bc5a363e063845cc |
| institution | Directory Open Access Journal |
| issn | 2341-4545 2387-1954 |
| language | English |
| last_indexed | 2024-12-14T15:05:19Z |
| publishDate | 2021-02-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | GE: Portuguese Journal of Gastroenterology |
| spelling | doaj.art-6fbd24c761ec4819bc5a363e063845cc2022-12-21T22:56:43ZengKarger PublishersGE: Portuguese Journal of Gastroenterology2341-45452387-19542021-02-011510.1159/000514015514015Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and EosinophiliaMaría del Mar Díaz AlcázarAdelina García RoblesJavier Luis López HidalgoDolores Quintero FuentesAlicia Martín-Lagos MaldonadoStrongyloides stercoralis is an intestinal nematode that colonizes and reproduces in the upper small intestinal mucosa. Infection in immunocompetent hosts is self-limited but in immunocompromised patients it can be complicated and cause hyperinfection. We present a 60-year-old female who was admitted due to an exacerbation of acquired thrombotic thrombocytopenic purpura requiring high doses of corticosteroids. The patient began to experience persistent pyrosis, nausea, vomiting, and oral intolerance. She was diagnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Upper endoscopy was performed and showed esophageal, gastric, and duodenal mucosa with edema and erythema. Moreover, there were superficial erosions and thickened folds in duodenum. Gastric and duodenal biopsies were taken. Abdominal computed tomography and magnetic enteroresonance displayed duodenal dilation and inflammatory changes. The histological study of biopsies showed colonization by S. stercolaris in the antrum and duodenum. S. stercolaris is a human parasite that is endemic in tropical, subtropical, and temperate regions. Its lifecycle is complex because it completes its entire cycle within the human host; it penetrates the skin, migrates to the lungs, and reach the gastrointestinal tract. The most affected site is the duodenum and upper jejunum. The lifecycle includes autoinfection through the intestinal mucosa or perianal skin, especially in immunocompromised hosts. Immunossuppression can lead to hyperinfection syndrome and disseminated disease. However, involvement of the stomach has relatively rarely been reported. SIADH has been related to systemic hyperinfection, although the mechanism is not clear. The relatively nonspecific clinical and imaging features and the low sensitivity of routine parasite tests make the diagnosis challenging and delayed.https://www.karger.com/Article/FullText/514015strongyloides stercoralishyperinfection syndromehyperemesisgastric mucosasyndrome of inappropriate secretion of antidiuretic hormone |
| spellingShingle | María del Mar Díaz Alcázar Adelina García Robles Javier Luis López Hidalgo Dolores Quintero Fuentes Alicia Martín-Lagos Maldonado Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia GE: Portuguese Journal of Gastroenterology strongyloides stercoralis hyperinfection syndrome hyperemesis gastric mucosa syndrome of inappropriate secretion of antidiuretic hormone |
| title | Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia |
| title_full | Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia |
| title_fullStr | Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia |
| title_full_unstemmed | Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia |
| title_short | Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Unusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia |
| title_sort | strongyloides stercoralis with gastroduodenal involvement and complicated with siadh an unusual diagnosis to consider in immunosuppressed patients with hyperemesis and eosinophilia |
| topic | strongyloides stercoralis hyperinfection syndrome hyperemesis gastric mucosa syndrome of inappropriate secretion of antidiuretic hormone |
| url | https://www.karger.com/Article/FullText/514015 |
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