Assuntos
Endossonografia , Fígado/patologia , Tumores Neuroendócrinos/diagnóstico por imagem , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , alfa-Fetoproteínas/análise , Fosfatase Alcalina/sangue , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Humanos , Intestino Delgado/diagnóstico por imagem , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/patologia , Pâncreas/patologia , Neoplasias Pancreáticas/patologia , Tomografia Computadorizada por Raios X , Transaminases/sangueRESUMO
Strongyloidiasis is a parasitic infection caused by nematode helminth Strongyloides stercoralis. Severe infection with S. stercoralis is rare and often missed by clinicians which may cause worsen the outcomes. A 57-year-old Hispanic female with past medical history of HIV and breast cancer was transferred from an outside hospital to a tertiary care facility with complaint of persistent abdominal pain and melena. She underwent Esophagogastroduodenoscopy (EGD) twice before her presentation for the same complaints which showed severe duodenitis with multiple erosions; however, at both occasions, biopsies were deferred. A third EGD done at tertiary care hospital also revealed severe duodenitis. Another notable finding was pseudo-membranous dusky appearing mucosa with duodenal narrowing causing gastric outlet obstruction (GOO). The duodenal mucosa involved was biopsied during EGD. Pathology was consistent with Strongyloidiasis. At that time, a diagnosis of severe Strongyloidiasis causing duodenal ulceration, bleeding, and GOO was made. She was started on Ivermectin. Her hospital course was further complicated by strongyloidiasis hyperinfection syndrome (SHS) leading to her demise. Severe infection with S. stercoralis causing SHS is associated with significant morbidity and mortality. High index of suspicion, timely diagnosis and management is prudent for preventing serious complications.