RESUMO
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Assuntos
Humanos , Feminino , Idoso , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Terapia Enzimática , Colangiocarcinoma/tratamento farmacológico , Tomografia Computadorizada por Raios X , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Colestase/complicações , Colangiopancreatografia por Ressonância Magnética/métodosAssuntos
Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares/diagnóstico por imagem , Colangiocarcinoma/diagnóstico , Colangite Esclerosante/diagnóstico por imagem , Endoscopia do Sistema Digestório/métodos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Idoso , Anti-Inflamatórios/uso terapêutico , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Colangite Esclerosante/diagnóstico , Colangite Esclerosante/tratamento farmacológico , Ducto Colédoco/diagnóstico por imagem , Diagnóstico Diferencial , Insuficiência Pancreática Exócrina/complicações , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Masculino , Prednisona/uso terapêutico , Indução de Remissão , Processamento de Sinais Assistido por ComputadorRESUMO
Introduction: Strongyloides has been shown to infrequently mimic inflammatory bowel disease (IBD) or to disseminate when a patient with IBD and unrecognized strongyloides is treated with immunosupression. Case report: A man from Ecuador, living in Spain for years, with a history of type 2 diabetes mellitus and psoriasis treated with topical corticosteroids, was admitted to the hospital with an 8-month history of diarrhoea. Blood tests showed hyperglycemia, hyponatremia, elevated CRP and faecal calprotectin. Colonoscopy suggested IBD. The patient improved with steroids, pending biopsy results, and he was discharged. Biopies were compatible with IBD, but careful examination revealed strongyloides. He was given a prescription of albendazole. He had to be readmitted due to SIADH, which resolved with fluid restriction. Upon discharge albendazole was prescribed again. The patient skipped most of the out-patientclinic visits. He returned a year later on 10 mg/week methotrexate, asymptomatic, with 20% eosinophilia, and admitting he had never taken the strongyloides treatment for economical reasons. He then received a week of oral albendazol at the hospital. Biopsies and blood cell count were afterwards normal (eosinophils 3.1%) and serology for strongyloides antibodies was negative. Discussion: This case is of interest for four rarely concurring reasons. It´s a worm infection that mimics IBD; the infection was diagnosed by colon biopsy; the infection caused a SIADH; and, most interestingly, even though the patient is on immunosupression, he remains asymptomatic (AU)
No disponible
Assuntos
Humanos , Masculino , Adulto , Estrongiloidíase/complicações , Estrongiloidíase , Hiperglicemia/complicações , Colonoscopia/métodos , Albendazol/uso terapêutico , Terapia de Imunossupressão/métodos , Terapia de Imunossupressão , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais , Hiponatremia/complicações , Esteroides/uso terapêutico , Metotrexato/uso terapêutico , Eosinofilia/complicações , Strongyloides stercoralis , Strongyloides stercoralis/isolamento & purificação , BiópsiaRESUMO
INTRODUCTION: Strongyloides has been shown to infrequently mimic inflammatory bowel disease (IBD) or to disseminate when a patient with IBD and unrecognized strongyloides is treated with immunosupression. CASE REPORT: A man from Ecuador, living in Spain for years, with a history of type 2 diabetes mellitus and psoriasis treated with topical corticosteroids, was admitted to the hospital with an 8-month history of diarrhoea. Blood tests showed hyperglycemia, hyponatremia, elevated CRP and faecal calprotectin. Colonoscopy suggested IBD. The patient improved with steroids, pending biopsy results, and he was discharged. Biopies were compatible with IBD, but careful examination revealed strongyloides. He was given a prescription of albendazole. He had to be readmitted due to SIADH, which resolved with fluid restriction. Upon discharge albendazole was prescribed again. The patient skipped most of the out-patient-clinic visits. He returned a year later on 10 mg/week methotrexate, asymptomatic, with 20% eosinophilia, and admitting he had never taken the strongyloides treatment for economical reasons. He then received a week of oral albendazol at the hospital. Biopsies and blood cell count were afterwards normal (eosinophils 3.1%) and serology for strongyloides antibodies was negative. DISCUSSION: This case is of interest for four rarely concurring reasons. It´s a worm infection that mimics IBD; the infection was diagnosed by colon biopsy; the infection caused a SIADH; and, most interestingly, even though the patient is on immunosupression, he remains asymptomatic.
Assuntos
Doenças Inflamatórias Intestinais/diagnóstico , Estrongiloidíase/diagnóstico , Adulto , Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Diagnóstico Diferencial , Humanos , Imunossupressores/uso terapêutico , Síndrome de Secreção Inadequada de HAD/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Doenças Inflamatórias Intestinais/parasitologia , Masculino , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/parasitologiaRESUMO
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