Fatal strongyloidosis following corticosteroid therapy in a patient with chronic idiopathic thrombocytopenia.

A patient with chronic idiopathic thrombocytopenia and fatal strongyloides hyperinfection syndrome following prolonged corticosteroid therapy is briefly described. Diagnosis was difficult to perform due to absence of eosinophilia and diarrhea at presentation, as well as to the negativity of multiple stool specimens examined by direct microscopy of saline smear, formol-ether concentration techniques, and Baermann's test. The striking hypoalbuminemia in the setting of the normal results of liver function tests and prothrombin time was assumed to be due to enteropathy. Therefore, an upper endoscopy was undertaken, revealing Strongyloides stercoralis (SS) larvae in the biopsy specimens of the gastric and duodenal mucosa. The SS larvae were also demonstrated in the multiple specimens of the concentrated sputum. Despite thiabendazol treatment, death ensued. On autopsy, SS larvae were recovered in the gastrointestinal tract and lungs. The importance of early diagnosis and of ruling out strongyloidosis prior to administration of corticosteroids are discussed, as well as the pathogenetic aspects of strongyloidosis in the patient under corticosteroids.

[Disseminated zygomycosis in patients with acute leukemia]. / Diseminovana zigomikoza kod bolesnika s akutnom leukemijom.

The authors present two patients with acute myeloid leukaemia and pulmonary-disseminated form of zygomycosis developed during the period of bone marrow aplasia. Diagnosis was established on necropsy on the basic of the patho-histological finding of wide, short and nonseptate hyphe with irregular branching. Hyphe were clearly recognized on Gomori methenamine Silver stained preparations. There were multiple haemorrhagic-necrotic infarcts of different organs due to the mycotic invasion of blood vessels. The authors discuss some some important diagnostic and therapeutic problems.