scholarly journals Strongyloides Infection in a Man with Abdominal Pain and a History of Rheumatoid Arthritis

2018 ◽  
Vol 10 (1) ◽  
pp. 23-28
Author(s):  
Fariborz Mansour-Ghanaei ◽  
Farahnaz Joukar ◽  
Alireza Samadi ◽  
Sara Mavaddati ◽  
Arash Daryakar
Keyword(s):  
Rheumatoid Arthritis ◽  
Severe Pain ◽  
Immunocompromised Patient ◽  
Gastrointestinal Symptoms ◽  
Strongyloides Stercoralis ◽  
Stool Examination ◽  
Immunocompromised Patients ◽  
Pathological Analysis ◽  
Immunosuppressive Medications ◽  
History Of

Background:Strongyloidiasis is self-limited by the complete immune system, it may be complicated and causes hyperinfection in immunocompromised patients. Objective: Here, we report a case of an immunocompromised patient with duodenal involvement ofStrongyloides stercoralis.Case Report:A 65-year-old man presented with severe pain in central abdomen and periumbilical regions. He had no history of alcohol consumption, smoking and surgery but the history of RA (Rheumatoid Arthritis) and hypothyroidism taking immunosuppressive medications. The patient underwent endoscopy and colonoscopy which pathological analysis of the biopsies revealed remarkable findings in favor of Strongyloidiasis. After two consecutive day’s consumption of ivermectin 200µg/kg, the symptoms were completely removed. Also, the stool examination was negative forS.stercoralislarvae two weeks after end of the treatment.Conclusions:It seems that in immunocompromised patients with gastrointestinal symptoms assumption of parasite-like infections such as Strongyloidiasis should be considered as one of the diagnosis options. Due to the physiological and gut microbial alternations, these patients are more susceptible to infectious diseases.

scholarly journals Sporotrichoid-Like Spread of Cutaneous Mycobacterium chelonae in an Immunocompromised Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Daria Marley Kemp ◽  
Anusha G. Govind ◽  
Jun Kang ◽  
Caroline C. Brugger ◽  
Young C. Kauh
Keyword(s):  
Lupus Erythematosus ◽  
Soft Tissues ◽  
Immunocompromised Patient ◽  
Immunocompromised Patients ◽  
Systemic Lupus ◽  
Mycobacterium Chelonae ◽  
Cutaneous Infections ◽  
Subcutaneous Nodules ◽  
Immunosuppressive Medications ◽  
Atypical Presentations

Mycobacterium chelonae is a rapidly growing mycobacterium found in water and soil that can cause local cutaneous infections in immunocompetent hosts but more frequently affects immunocompromised patients. Typically, patients will present with painful subcutaneous nodules of the joints or soft tissues from traumatic inoculation. However, exhibiting a sporotrichoid-like pattern of these nodules is uncommon. Herein, we report a case of sporotrichoid-like distribution of cutaneous Mycobacterium chelonae in a patient with systemic lupus erythematosus on significant immunosuppressive medications. Clinicians treating immunocompromised patients should be cognizant of their propensity to develop unusual infections and atypical presentations.

scholarly journals The Importance of Screening Strongyloides stercoralis Infection in Solid Organ Transplant Donors and Recipients

2021 ◽  
Vol 16 (4) ◽  
Author(s):  
Sara Abolghasemi ◽  
Farnaz Zolfaghari ◽  
Shahnaz Sali ◽  
Abdollah Ghaffari ◽  
Mehran Noori
Keyword(s):  
Organ Transplant ◽  
Gastrointestinal Symptoms ◽  
Strongyloides Stercoralis ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Kidney Transplant Recipients ◽  
Place Of Residence ◽  
Birth Place ◽  
Immunosuppressed Patients ◽  
History Of

Background: Strongyloides stercoralis is an intestinal nematode with worldwide distribution which is endemic in tropical and subtropical areas. It is unique in its ability to complete its entire life cycle and reinfect its human host via a phenomenon called autoinfection. The majority of infections are clinically asymptomatic or can manifest with gastrointestinal symptoms, such as heartburn, bloating, diarrhea, abdominal discomfort, gastroesophageal reflux disease (GERD), or symptoms related to the penetration of larvae through skin, including dermatitis and eosinophilia. Immunosuppressed patients, such as solid organ transplant patients with untreated strongyloidiasis are at great risk of hyperinfection, dissemination syndromes, and often fatal conditions associated with strongyloidiasis. Methods: In this retrospective single-center cross-sectional study, we evaluated 157 cases (131 heart, lung, and kidney transplant recipients and 26 kidney donors) in Tehran, Iran, from March 2020 to April 2021. Demographic information including age, gender, place of birth, place of residence, underlying disease, being the donor or recipient, history of previous transplant and type of transplant, travel history to endemic regions, and seropositivity for S. stercoralis were evaluated. Results: Among 157 cases with a mean age of 38.9 years, 40 (25.5%) cases tested positive for S. stercoralis antibodies. Out of 26 donors, eight cases were seropositive, and among 131 recipients, 32 cases were seropositive. There was no significant correlation between birth place and place of residence in endemic areas and seropositivity for S. stercoralis. None of the cases showed hypereosinophilia, hyperinfection, or disseminated syndrome. Also, we found no significant correlation between the type and time of transplant, history of previous transplants, and S. stercoralis infection. Conclusions: Universal screening for S. stercoralis latent infection is important in immunosuppressed patients, especially in solid organ transplants because of the high risk of hyperinfection and disseminated syndrome, which may culminate in death. Furthermore, screening for latent strongyloides infection in donors seems to be necessary because of the possibility of strongyloides infection being transmitted from donors to recipients.

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 Staphylococcus warneri meningitis in a patient with Strongyloides stercoralis hyperinfection and lymphoma: first report of a case

2010 ◽  
Vol 52 (3) ◽  
pp. 169-170 ◽  
Author(s):  
Renzo Nino Incani ◽  
Marcos Hernández ◽  
Jackeline Cortez ◽  
María Elena González ◽  
Yaimir Dorel Salazar
Keyword(s):  
Cell Lymphoma ◽  
Gastrointestinal Symptoms ◽  
Strongyloides Stercoralis ◽  
Staphylococcus Warneri ◽  
Hyperinfection Syndrome ◽  
History Of ◽  
Cerebrospinal Fluid Culture ◽  
Mantel Cell Lymphoma ◽  
First Time ◽  
Fluid Culture

A case of meningitis due to Staphylococcus warneri in a patient with a hyperinfection with Strongyloides stercoralis possibly associated with rituximab treatment for mantel cell lymphoma is reported for the first time in the literature. The patient was a 59-year-old woman, with a 3-year history of an apparently well controlled lymphoma after treatment with chemotherapy-immunotherapy and then immunotherapy alone, and diagnosis of strongyloidiasis. Meningitis was diagnosed by cerebrospinal fluid culture and tested with an automated plate system. The patient was successfully treated with vancomycin; although fever and productive cough persisted. Severe gastrointestinal symptoms and pneumonia developed three weeks later. Hyperinfection syndrome by S. stercoralis was diagnosed, with abundant larvae in feces and expectoration.

scholarly journals MON-693 Strongyloides Stercoralis Hyper Infestation Syndrome in Type 2 Diabetes: An ANCA Positive Case Report from India

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Kalpana Dash ◽  
Surekha Tippisetty ◽  
Vamsi Krishna Kolukula
Keyword(s):  
Molecular Mimicry ◽  
Past History ◽  
Parasite Load ◽  
Strongyloides Stercoralis ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Total Leukocyte Count ◽  
Stool Examination ◽  
Laboratory Findings ◽  
Precise Diagnosis ◽  
History Of

Abstract A 53-year old male patient with T2D and hypertension for 13 years, presented to Apollo Sugar Clinic, Raipur with recurrent abdomen pain, but no vomiting, constipation, diarrhea or fever. The patient has a past history of asthmatic bronchitis, recurrent eosinophilia, and one month prior to hospitalization, recovered from erythematous maculopapular serpentine rash measuring 6.0 x 1.5 cm over the abdomen post anti-allergic treatment. The patient was neither suffering from immunosuppressive condition nor was on immunosuppressant therapy, had normal vitals but the laboratory findings revealed high total leukocyte count and raised absolute eosinophil count (52%). The provisional diagnosis was made as hypereosinophilic enteritis in a long-standing T2D and hypertension. Immunological tests antinuclear antibody (ANA) and antineutrophil cytoplasmic antibodies (ANCA) resulted in positive ruling out vasculitis. Stool examination detected rhabditiform larvae of S Stercoralis and diagnosed as Strongyloides hyper infestation syndrome. The patient was managed with IV antibiotics, IV fluids, IV insulin and when abdomen pain reduced started with the oral diet. To remove larvae load, unlike routine treatment, the patient was put on albendazole and ivermectin for three consecutive days. After 15 days follow-up patient was completely asymptomatic; at 6 weeks TLC, stool test, ANCA and ANA titer were negative indicating no parasite load. These antibodies detected could be due to molecular mimicry triggered by parasite antigens which may help in diagnosing and monitoring the disease course. ANA and ANCA positive results have been rarely reported in the past for S stercoralis. This unique case of S stercoralis infestation in T2D may enlighten the health care physicians to investigate for this infestation in immunocompromised T2D patients with pain abdomen. Precise diagnosis with timely management can prevent steroid therapy due to eosinophilic enteritis which can be harmful to the patients.

scholarly journals Fatal Disseminated Mucormycosis in a Hematological Immunocompromised Patient with Extensive Voriconazole Exposure: A Case Report and Review of the Literature

2020 ◽  
Vol 12 (3) ◽  
pp. 168-173 ◽  
Author(s):  
Victoria S. Humphrey ◽  
Xiaoxiao Li ◽  
Sonal Choudhary ◽  
Timothy Patton
Keyword(s):  
Immunocompromised Patient ◽  
Lymphoblastic Leukemia ◽  
Hematologic Malignancies ◽  
Immunocompromised Patients ◽  
Past Medical History ◽  
Review Of The Literature ◽  
History Of ◽  
Cell Acute Lymphoblastic Leukemia ◽  
Cutaneous Mucormycosis ◽  
Disseminated Mucormycosis

Disseminated mucormycosis is a rare, opportunistic, and aggressive infection typically presenting in immunocompromised patients. Herein, we report a 55-year-old male with a past medical history of Philadelphia-negative B-cell acute lymphoblastic leukemia who presented with a 2-month history of non-painful necrotic ulcers on the nose, knuckles, elbow, foot, and scrotum following 3 months of voriconazole (VRC) exposure in the setting of an unrelated fungal pneumonia. Our case reinforces the virulent and often fatal nature of the disease amongst immunocompromised patients, along with extensive VRC exposure as a possible supplementary risk factor. Disseminated cutaneous mucormycosis should be regarded as a differential diagnosis in all immunocompromised patients, especially those with hematologic malignancies or a history of VRC use, who present with cutaneous ulcerations and eschars.

scholarly journals E. coliMeningitis Presenting in a Patient with DisseminatedStrongyloides stercoralis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Juliana B. Gomez ◽  
Yvan Maque ◽  
Manuel A. Moquillaza ◽  
William E. Anicama
Keyword(s):  
Gastrointestinal Symptoms ◽  
Abdominal Distension ◽  
Strongyloides Stercoralis ◽  
The Body ◽  
Case Presentation ◽  
E Coli ◽  
History Of ◽  
Disseminated Strongyloidiasis ◽  
Proper Diagnosis ◽  
Cerebrospinal Fluid Culture

Introduction. SpontaneousEscherichia colimeningitis is an infrequent condition in adults and is associated with some predisposing factors, including severeStrongyloides stercoralis(SS) infections.Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell’s palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrumβ-lactamase producingE. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multipleStrongyloideslarvae throughout the body.Conclusion.Strongyloides stercoralisinfection should be excluded in adults with spontaneousE. colimeningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.

scholarly journals Delayed Diagnosis: Tuberculous Arthritis of Right Knee Joint in a Patient with Rheumatoid Arthritis

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
H. Senarathna ◽  
K. Deshapriya
Keyword(s):  
Rheumatoid Arthritis ◽  
Knee Joint ◽  
Delayed Diagnosis ◽  
Sri Lankan ◽  
Tuberculous Arthritis ◽  
Immunosuppressive Medications ◽  
History Of ◽  
One Year ◽  
Tb Pcr ◽  
High Degree

Background. Though skeletal tuberculosis (TB) accounts about 3% of all TB cases, it occupies 10–35% of extrapulmonary TB cases. Common osteoarticular sites involved include the spine (40%), hip (25%), and knee (8%). Co-occurrence of rheumatoid arthritis (RA) and tuberculous arthritis involving peripheral joint is rarely reported in the literature. Case Presentation. We present a case of 42-year-old Sri Lankan-Sinhalese male with right knee joint pain and swelling for one-year duration. This patient had a history of long-standing RA with interstitial lung disease for which he was on multiple immunosuppressive medications including methotrexate, sulfasalazine, leflunomide, mycophenolate mofetil, and prednisolone. His knee joint aspiration fluid was positive for both acid fast bacilli (AFB) and polymerase chain reaction for TB (TB-PCR). He was started on anti-tuberculous chemotherapy. Conclusion. TB should be considered as an important differential diagnosis for chronic mono-arthritis of knee joint with a high degree of suspicion, particularly where TB is endemic.

scholarly journals A case of sigmoid volvulus in an unexpected demographic

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohammad Saba ◽  
Joshua Rosenberg ◽  
Gregory Wu ◽  
Gudata Hinika
Keyword(s):  
Abdominal Pain ◽  
Severe Pain ◽  
Rare Case ◽  
Young Female ◽  
Sigmoid Volvulus ◽  
Case Presentation ◽  
Operative Complications ◽  
History Of ◽  
Male Sex ◽  
Emergent Laparotomy

Abstract Background A sigmoid volvulus occurs when a segment of the colon twists upon its mesentery. This infliction is associated with old age, multiple co-morbidities, and the male sex. We present a rare case of sigmoid volvulus that occurred in a healthy young female. Case presentation A 28-year-old female presented with a one week history of constipation and abdominal pain. Her symptoms suddenly worsened and became associated with vomiting and severe pain. A focused history taking and physical examination showed peritoneal signs that led to timely diagnostic imaging to be implemented. Computed tomography (CT) of the abdomen was consistent with sigmoid volvulus. Our patient underwent emergent laparotomy with a sigmoidectomy and recovered with no post-operative complications. Conclusion This case report emphasizes the importance of clinicians maintaining a sigmoid volvulus as a rare, yet important differential when approaching abdominal pain in young healthy patients.

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