A case of chronic strongyloidiasis diagnosed by histopathological study

Medical

Imagery

A

case

of

chronic

strongyloidiasis

diagnosed

by

histopathological

study

ARTICLE INFO

Articlehistory:

Received8August2018

Receivedinrevisedform10September2018

Accepted12September2018

CorrespondingEditor:EskildPetersen,

Aar-hus,DenmarkKeywords:

Strongyloidiasis

Strongyloidesstercoralis

Histopathologicalfinding

An83-year-oldItalianmanlivingintheprovinceofVeronain thenortheastofItaly,presentedwithcomplaintsofepigastricpain, nausea,vomiting,constipationfor2weeks,anda3-monthhistory of diffuse pruritus. He also reported colonic diverticulosis and chronicobstructivepulmonarydisease,withtworecentepisodes of pneumonia.His medicationsincluded beclometasone/formo-terol100

m

g/6

m

gdeliveredviaapressurizedmetereddoseinhaler. Henevertravelledabroadandhereportedahistoryoffarmwork sinceyouth.

Laboratorytestsshowedhaemoglobinof96g/l(normalvalue 140–180g/l) and eosinophils of 2.2109_{/l (normal count 0–}

0.5109_{/l). Oesophagogastroduodenoscopy showed signs of}

gastric and duodenal atrophy with petechial lesions (Figure 1a, b). Histological assessment (haematoxylin–eosin, 200)

showedchronicinfiltrationwithalargeamountofeosinophils around numerous helminth forms identified as larvae of Strongyloidesstercoralis(Figure1b,c). Thediagnosisof strongy-loidiasiswasconfirmedbyindirectimmunofluorescenceantibody test(titre1:320).Corticosteroidswerediscontinuedandasingle oral dose of ivermectin (200

m

g/kg) was administered. The patient_’ssymptomsresolvedandhiseosinophilcountnormalized within3months.

Strongyloidiasis is a soil-transmitted nematode infection, commonlyasymptomatic,thatwasonceendemicinsomeareas ofdevelopedcountries,includingNorthernItaly(Buonfrateetal., 2016). The misdiagnosis in a patient chronically treated with corticosteroids,orwithanyothercauseofimmunosuppression, can resultina hyperinfectionor themoreseveredisseminated

https://doi.org/10.1016/j.ijid.2018.09.007

1201-9712/©2018TheAuthor(s).PublishedbyElsevierLtdonbehalfofInternationalSocietyforInfectiousDiseases.ThisisanopenaccessarticleundertheCCBY-NC-ND

license(http://creativecommons.org/licenses/by-nc-nd/4.0/).

InternationalJournalofInfectiousDiseases77(2018)1–2

ContentslistsavailableatScienceDirect

International

Journal

of

Infectious

Diseases

disease,whichhasacasefatalityratecloseto100%(Fardetetal., 2007;RamanathanandNutman,2008;MejiaandNutman,2012). Fundingsource

None. Ethicalapproval

Informedconsentforthepublicationofallimageswasgivenby thepatient.

Conflictofinterest

Noconflictofinteresttodeclare. References

BuonfrateD,BaldisseraM,AbresciaF,BassettiM,CaramaschiG,GiobbiaM,etal. Epidemiology of Strongyloides stercoralis in northern Italy: results of a multicentre case-controlstudy, February 2013to July2014. Euro Surveill 2016;21(31),doi:http://dx.doi.org/10.2807/1560-7917.ES.2016.21.31.30310.

Fardet L, Genereau T, Poirot JL, Guidet B, Kettaneh A, Cabane J. Severe strongyloidiasisincorticosteroid-treatedpatients:caseseriesandliterature review. J Infect 2007;54(1):18–27, doi:http://dx.doi.org/10.1016/j. jinf.2006.01.016.

MejiaR, NutmanTB.Screening, prevention, andtreatment forhyperinfection syndromeanddisseminatedinfectionscausedbyStrongyloidesstercoralis.Curr Opin Infect Dis 2012;25(4):458–63, doi:http://dx.doi.org/10.1097/QCO.0-b013e3283551dbd.

RamanathanR,NutmanT.Strongyloidesstercoralisinfectioninthe immunocom-promisedhost.CurrInfectDisRep2008;10(2):105–10.

AnnaBeltramea,_*

LauraBortesib

MarcoBeninic

ZenoBisoffia

a_{CentreforTropicalDiseases,IRCCSSacroCuoreDonCalabria}

Hospital,ViaSempreboni5,37024Negrar,Italy

b_{DepartmentofPathology,IRCCSSacroCuoreDonCalabriaHospital,}

ViaSempreboni5,37024Negrar,Italy

c_{DepartmentofGastroenterologyandEndoscopy,IRCCSSacroCuore}

DonCalabriaHospital,ViaSempreboni5,37024Negrar,Italy * Correspondingauthor. E-mailaddresses:anna.beltrame@sacrocuore.it(A.Beltrame),

laura.bortesi@sacrocuore.it(L.Bortesi),

marco.benini@sacrocuore.it(M.Benini),

zeno.bisoffi@sacrocuore.it(Z.Bisoffi). CorrespondingEditor:EskildPetersen,Aarhus,Denmark Received8August2018 Receivedinrevisedform10September2018 Accepted12September2018

(a) (b)

(d) (c)

Figure1.Endoscopicandhistopathologicalfindingsin83-years-oldpatientwithchronicstrongyloidiasis.Esophagogastroduodenoscopyshowedsignsofpetechiallesions

andgastric(a)andduodenalatrophy(b).Histologicalassessment(H&E;200)showedchronicactiveinflammationwithvillousatrophy(c)andchronicgastritis(d)bothwith

alargeamountofeosinophilsaroundnumerouslongitudinalandcrosssectionlarvaeofStrongyloidesstercoralis(c–d).