scholarly journals Invasive enteritis by Strongyloides stercoralis presenting as acute abdominal distress under corticosteroid therapy

2001 ◽  
Vol 56 (4) ◽  
pp. 103-106 ◽  
Author(s):  
Maria Aparecida Marchesan Rodrigues ◽  
Raquel Cardoso Fróes ◽  
Alexandre Anefalos ◽  
Shoiti Kobayasi
Keyword(s):  
Differential Diagnosis ◽  
Immunosuppressive Therapy ◽  
Corticosteroid Therapy ◽  
Strongyloides Stercoralis ◽  
Sao Paulo ◽  
Immunocompromised Patients ◽  
Surgical Specimen ◽  
Endemic Areas ◽  
One Year ◽  
Abdominal Distress

Overwhelming helminthiasis is still a problem in endemic areas, especially in immunocompromised patients. We report a case of invasive intestinal strongyloidiasis that was clinically expressed as acute abdominal distress in a 73-year-old man from São Paulo who had been receiving methylprednisone, 20 mg/day, for one year for osteoarthritis. A surgical specimen from the ileum revealed invasive enteritis with severe infestation by Strongyloides stercoralis. The patient died of sepsis 6 days after surgery. The possibility of invasive strongyloidiasis should be considered in the differential diagnosis of acute abdominal distress in patients undergoing immunosuppressive therapy.

scholarly journals Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasis

2019 ◽  
Vol 4 (1) ◽  
pp. 35 ◽  
Author(s):  
Prakash Shrestha ◽  
Sean E. O’Neil ◽  
Barbara S. Taylor ◽  
Olaoluwa Bode-Omoleye ◽  
Gregory M. Anstead
Keyword(s):  
Developing Countries ◽  
Differential Diagnosis ◽  
Immunocompromised Patient ◽  
Strongyloides Stercoralis ◽  
Immunocompromised Patients ◽  
Secondary Infections ◽  
Immunosuppressed Patients ◽  
Disseminated Strongyloidiasis ◽  
The Tropics ◽  
Candida Pneumonia

Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis.

scholarly journals A “Terrible” Headache in a HIV Patient

2021 ◽  
pp. 014556132110141
Author(s):  
Marios Stavrakas ◽  
Ioannis Koskinas ◽  
Jannis Constantinidis ◽  
Petros D Karkos
Keyword(s):  
Differential Diagnosis ◽  
Surgical Treatment ◽  
Fungal Infection ◽  
Early Identification ◽  
Fungal Sinusitis ◽  
Immunocompromised Patients ◽  
Immunosuppressed Patients ◽  
Distant Spread ◽  
Nose And Throat

Mucormycosis is a type of fungal infection more prevalent among immunosuppressed patients, requires prompt identification and surgical treatment, as it can is associated with local and distant spread. This case is aiming to highlight the importance of early identification of subtle symptoms in immunocompromised patients. The clinician should be aware of fungal sinusitis, consider it in the differential diagnosis, and seek for an ear, nose, and throat opinion.

scholarly journals A case of fatal disseminated strongyloidiasis accompanied with intestinal obstruction

2019 ◽  
Vol 2019 (10) ◽  
Author(s):  
Peyman Heydarian ◽  
Iraj Mobedi ◽  
Mohamad Ali Mohaghegh ◽  
Abozar Hosseini ◽  
Fatemeh Goudarzvand Chegini ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Signs And Symptoms ◽  
Strongyloides Stercoralis ◽  
Final Diagnosis ◽  
High Humidity ◽  
Important Message ◽  
Disseminated Strongyloidiasis ◽  
Endemic Areas

Abstract Strongyloides stercoralis is an endemic parasite in some regions including the tropical and subtropical areas with high humidity. Most infections are asymptomatic with nonspecific signs and symptoms, making the final diagnosis complicated. Here, we report a patient referred to our hospital with signs consistent with sepsis, intestine obstruction, which finally died with the diagnosis of strongyloidiasis. The patient was from northern parts of Iran which are considered as endemic areas for S. stercoralis. In conclusion, there is an important message in this history, i.e. physicians should be aware of specific and non-specific signs of strongyloidiasis especially in people living in endemic areas to make an accurate final diagnosis by proper clinical and paraclinical examinations.

Toxoplasma Appendicitis: A Once-in-a-Lifetime Diagnosis!

2017 ◽  
Vol 26 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Anisha M. Fernandes ◽  
Maheshkumar M. Lakhe ◽  
Sanjay A. Pai
Keyword(s):  
Differential Diagnosis ◽  
Acute Appendicitis ◽  
Muscularis Propria ◽  
Immunocompromised Patients ◽  
Lymphoid Follicles ◽  
Negative Results ◽  
Immunosuppressed Patients ◽  
Life Threatening

Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but it can be life-threatening in immunocompromised patients. We present a case of a 62-year-old man with clinical features of acute appendicitis. Histology showed a transmural infiltrate of eosinophils. In addition, there were reactive lymphoid follicles with histiocytes in the submucosa and tachyzoites in the muscularis propria. Immunohistochemistry confirmed the diagnosis of toxoplasma appendicitis. Serological evaluation yielded negative results. Retrospective review of the history revealed that the patient was on long-term immunosuppressive therapy with methotrexate. The patient was treated with sulfamethoxazole-trimethoprim and is asymptomatic at 7-month follow-up. Toxoplasma appendicitis must be considered in the differential diagnosis of appendicitis in immunosuppressed patients.

scholarly journals Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

2021 ◽  
pp. 148-153
Author(s):  
Tetsuko Sato ◽  
Takenobu Yamamoto ◽  
Yumi Aoyama
Keyword(s):  
Herpes Zoster ◽  
Early Diagnosis ◽  
Varicella Zoster Virus ◽  
Immunosuppressive Therapy ◽  
Unusual Case ◽  
Cranial Nerves ◽  
Skin Lesions ◽  
Immunocompromised Patients ◽  
Aggressive Treatment ◽  
Varicella Zoster

Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

scholarly journals Schwannoma of the abdominal wall: updated literature review

2021 ◽  
Author(s):  
Tommaso Panici Tonucci ◽  
Andrea Sironi ◽  
Eleonora Pisa ◽  
Benedetta Di Venosa ◽  
Luigi Bonavina
Keyword(s):  
Differential Diagnosis ◽  
Literature Review ◽  
Abdominal Wall ◽  
Single Case ◽  
Case Reports ◽  
Rectus Abdominis ◽  
Malignant Neoplasms ◽  
Palpable Mass ◽  
Surgical Specimen ◽  
Benign Schwannoma

Summary Background Schwannoma is a benign tumor arising from Schwann cells of the peripheral nerves. It is often asymptomatic and can develop in the retroperitoneum, mediastinum, head and neck region, and upper and lower extremities. Schwannoma of the abdominal wall is extremely rare, but differential diagnosis with malignant neoplasms is important to reduce the risk of undertreatment. Methods A narrative review of abdominal wall schwannoma was performed using PubMed, EMBASE, and Web of Science database and the search terms “schwannoma”, “neurinoma”, “neurilemmoma”, “soft tissue tumors”, “neurogenic tumor”, “rectus abdominis mass”, “abdominal wall”. In addition, the hospital charts were reviewed to report the personal experience. Results Only 9 single case-reports of benign schwannoma of the abdominal wall were found in the English medical literature over the past decade. None of the patients received preoperative biopsy and all were resected with clear margins. In addition to the literature review, we report the case of a 58-year-old man referred for a palpable mass in the left upper abdominal quadrant. Ultrasonography and magnetic resonance imaging revealed a solid and well-encapsulated mass inside the left rectus abdominis muscle. A core biopsy of the lesion provided the diagnosis of cellular schwannoma and this was confirmed by histopathologic examination of the surgical specimen. Conclusions Benign schwannoma of the abdominal wall is extremely rare. Percutaneous core needle biopsy is important for the differential diagnosis with more common and biologically more aggressive malignancies, such as desmoid tumors and sarcomas, and may be relevant for planning the most appropriate management.

Histopathology of Gastric and Duodenal Strongyloides stercoralis Locations in Fifteen Immunocompromised Subjects

2006 ◽  
Vol 130 (12) ◽  
pp. 1792-1798 ◽  
Author(s):  
Francesco Rivasi ◽  
Silvio Pampiglione ◽  
Renzo Boldorini ◽  
Loredana Cardinale
Keyword(s):  
Colorectal Adenocarcinoma ◽  
Parasitic Infection ◽  
Strongyloides Stercoralis ◽  
Duodenal Mucosa ◽  
Gastric Ulcers ◽  
Immunocompromised Patients ◽  
Histologic Diagnosis ◽  
Immunodeficiency Virus ◽  
Gastric Biopsies ◽  
Duodenal Biopsies

Abstract Context.—Strongyloidiasis is a worldwide parasitic infection affecting approximately 75 million people. In Italy, it was more prevalent in the past among rural populations of irrigated areas. Objective.—To determine the histopathologic alterations of the gastric and duodenal mucosa associated with the presence of Strongyloides stercoralis parasites. Design.—Fifteen cases of strongyloidiasis were observed in immunocompromised patients during a recent 6-year period in Italy. S stercoralis was found histologically in gastric biopsies (10 cases), in a gastrectomy (1 case), and in duodenal biopsies (9 cases). In 5 cases the parasite was present both in gastric and duodenal biopsies. Four patients were affected by lymphoma, 2 by multiple myeloma, 2 by gastric carcinoma, 1 by chronic myeloid leukemia, 1 by sideroblastic anemia, 1 by colorectal adenocarcinoma, 1 by chronic idiopathic myelofibrosis, 1 by chronic gastritis, 1 by gastric ulcers, and 1 by rheumatoid arthritis in corticosteroid therapy. No patient was affected by human immunodeficiency virus infection. Strongyloidiasis was not clinically diagnosed. Results.—Histologic examination revealed several sections of S stercoralis larvae, many eggs, and some adult forms. All the parasites were located in the gastric and/or the duodenal crypts. Eosinophils infiltrating into the lamina propria were found in all cases; their intensity was correlated with the intensity of the infection. Conclusions.—Histologic diagnosis of strongyloidiasis must be taken into consideration when examining both gastric and duodenal biopsies in immunocompromised patients, to avoid the development of an overwhelming infection of the parasite, which is dangerous for the life of the patient.

scholarly journals Visceral leishmaniasis and Acquired Immunodeficiency Sydrome (AIDS): case report

1994 ◽  
Vol 36 (4) ◽  
pp. 385-387 ◽  
Author(s):  
G.M. de C. Viana ◽  
D.S. Lewi ◽  
P. Olzon ◽  
C.M. Freire ◽  
V.M. Morelli ◽  
...  
Keyword(s):  
Case Report ◽  
Visceral Leishmaniasis ◽  
Opportunistic Infection ◽  
Immunocompromised Patients ◽  
Developing Regions ◽  
Disseminated Tuberculosis ◽  
Endemic Diseases ◽  
Acquired Immunodeficiency ◽  
Endemic Areas

This is a case report that describe an association of AIDS, visceral leishmaniasis and probable disseminated tuberculosis. Due to the spread of AIDS in developing areas worldwide this association would be more frequently, seen on subjects from endemic areas where this protozoonosis is prevalent. More than one opportunistic infection related with the endemic diseases of the developing regions can be associated with those immunocompromised patients.

scholarly journals Prevalence of intestinal parasitic infection in five farms in Holambra, São Paulo, Brazil

1995 ◽  
Vol 37 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Jun Kobayashi ◽  
Hideo Hasegawa ◽  
Archimedes A. Forli ◽  
Nancy F. Nishimura ◽  
Ademar Yamanaka ◽  
...  
Keyword(s):  
Parasitic Infection ◽  
Strongyloides Stercoralis ◽  
Sao Paulo ◽  
São Paulo ◽  
Infection Rates ◽  
Blastocystis Hominis ◽  
Culture Methods ◽  
E Coli ◽  
Parasitological Survey ◽  
Protozoan Species

A parasitological survey was carried out on 222 inhabitants of five farms in Holambra, located 30 km north of Campinas, São Paulo, Brazil, on October 1992. Approximately 70% of the inhabitants were found to be infected with at least one species of intestinal parasite. The positive rates of 6 helminths and 7 protozoan species detected are as follows: 5.4% Ascaris lumbricoides; 8.6% Trichuris trichiura; 19.8% Necator americanus; 10.4% Strongyloides stercoralis; 14% Enterobius vermicularis; 0.9% Hymenolepis nana; 3.2% Entamoeba histolytica; 2.7% E. hartmanni; 9.9% E. coli; 14.0% Endolimax nana; 2.3% Iodamoeba butschlii; 10.4% Giardia lamblia; 37.8% Blastocystis hominis. The positive rates of helminth infection were generaly higher in the younger-group under 16 years-old than those in the elder group aged 16 or more, whereas the infection rates of protozoan species were higher in the elder group. The infection rate of Strongyloides was found to be 10.4% by a newly developed sensitive method (an agarplate culture methods).

scholarly journals Giant jejunal gasto-intestinal stromal tumor: A rare cause of abdominal mass in an elderly female

2021 ◽  
Vol 1 (2) ◽  
pp. 65-67
Author(s):  
AC Diallo ◽  
A Ndong ◽  
I Niang ◽  
MB Ba ◽  
JA Thiam ◽  
...  
Keyword(s):  
Abdominal Mass ◽  
Pelvic Mass ◽  
Final Diagnosis ◽  
Progressive Increase ◽  
Stromal Tumor ◽  
Biological Assessment ◽  
Pathological Examination ◽  
Tissue Mass ◽  
Surgical Specimen ◽  
One Year

OBJECTIVE: We report the case of a patient presenting an abdominal mass whose final diagnosis is a gastrointestinal stromal tumor (GIST). CLINICAL OBSERVATION: It was a 61-year-old patient with no pathological history received for a progressive increase in the volume of the abdomen evolving for one year and painless. On examination, the patient was in good general condition, with normal patterns. There was an abdomino-pelvic mass of about 20 cm long axis, mobile. The rest of the exam was unremarkable. The biological assessment was normal. Abdominopelvic computed tomography revealed a tissue mass with necrosis. During the surgical exploration, a mass developed on the mesenteric border 45 cm from the Treitz angle was noted. It is not associated with ascites or peritoneal carcinoma. Bowel resection removing the mass was performed followed by end-to-end anastomosis. Pathological examination of the surgical specimen diagnosed GIST. The postoperative course at three months was excellent both clinically and radiologically. CONCLUSION: The case that we report underlines the possible jejunal localization of GIST and the clinical presentation may be usual. It also shows the difficulty of obtaining a preoperative diagnosis and the central role of surgery in management.

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