[Duodenal obstruction by Strongyloides stercoralis, an unusual complication]. / Obstrucción duodenal por Strongyloides stercoralis, una complicación inusual.

Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.

E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis.

Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides 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 spectrum ß -lactamase producing E. 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 multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, 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.

Biopsia de grasa subcutánea para el diagnóstico de amiloidosis secundaria en artritis reumatoide / Subcutaneous fat biopsy to diagnose secondary amyloidosis in patients with rheumatoid arthritis

OBJETIVO: Investigar la presencia de amiloidosis secundaria (AA) en pacientes con diagnóstico de artritis reumatoide (AR). MATERIALES Y MÉTODOS: Se evaluó tiempo de enfermedad (TE), presencia de manifestaciones extraarticulares, capacidad funcional y estadio de progresión anatómica, hemograma, velocidad de sedimentación globular, factor reumatoide (FR) (Test de Látex), albúmina sérica y examen completo de orina. Se realizó aspirado de grasa subcutánea periumbilical. El tejido se coloreó con rojo Congo y observó por microscopía óptica y luz polarizada, siendo positiva la birrefringencia verde manzana. RESULTADOS: Se estudió 81 pacientes con diagnóstico de AR (criterios del ACR), 71 fueron mujeres y 10 varones, con rango de edad 31 a 80 años. 75/81 fueron FR (+), 3/81 AA (+). El TE promedio fue 14,74 años para los AA (-) y 20,3 para los AA (+). Sólo en un paciente se halló amiloide en biopsia renal. CONCLUSIONES: En nuestra serie la frecuencia fue menor a lo reportado. Los pacientes con amiloidosis tuvieron títulos altos de FR y TE más prolongado.