Journal of Pathology and Translational Medicine

Case Report

Strongyloidiasis of Gastric and Colonic Mucosa in a Patient with Monoclonal Gammopathy of Undetermined Significance: A Case Report.: Jung Uee Lee, Sang Bum Kang, Hae Joung Sul, Jong Ok Kim; Korean J Pathol. 2011;45:S75-S78.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S75

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Here we report a case of Strongyloides stercoralis infection of the gastric and pancolonic mucosa in a 79-year-old female with a monoclonal gammopathy of undetermined significance. Endoscopic biopsies were performed in gastric antrum, cecum, distal ascending colon, and hepatic flexure of the colon. On microscopic examination, there were many adult worms, larvae and eggs in the gastric and colonic mucosa. Worms, larvae, and eggs were located in the crypts and within the lumen of the crypts. The body wall of the adult worm was composed of cuticle and a weak muscle layer. A routine stool examination failed to detect larvae or ova. Based on the histopathologic examination, these parasites were confirmed as S. stercoralis.

Citations

Citations to this article as recorded by

Is Gastric Involvement by Strongyloides stercoralis in an Immunocompetent Patient a Common Finding? A Case Report and Review of the Literature
Irene Pecorella, Tom Richard Okello, Gaia Ciardi, David Martin Ogwang
Acta Parasitologica.2022; 67(1): 94. CrossRef

Original Article

Cutaneous Infection of Larval strongyloides stercoralis Manifesting Pseudolymphomatous Reactions.: Jin Hee Sohn, Hye Rim Park, Kye Yong Song, Seung Yull Cho; Korean J Pathol. 1996;30(5):466-469.

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Abstract PDF: Larval nematodes belonging to genera Ancylostoma, Strongyloides, Rhabditis, Gnathostoma or microfilariae (Onchocerca volvulus)/adult filaria (Loa loa) can invade human skin, each making different lesion. In a 71-year old immunocompetent Koreanman with 23% eosinophilia and elevated serum IgG (2530 mg/dl), a skin biopsy was undertaken for a nodular lesion at abdominal wall. A longitudinal section of a larval nematode was recognized in mid-dermal tunnel surrounded by pseudolymphomatous diffuse lymphoreticular cell infiltration. The larval nematode, 15 um in maximum diameter, had outermost cuticular layer and pale intestinal cells. The nematode section was identified as a filariform larva of Strongyloides stercoralis mainly based on its maximum diameter. In Korea, this is the first description of a cutaneous larval nematode infection. This case did not show quick migration of lesion which is a typical manifestation of classical cutaneous larva migrans.

Case Reports

Fatal Strongyloidiasis with Residual Cutaneous Larvae: An Autopsy Case Report.: Na Rae Kim, Dae Su Kim, Joungho Han, Dong Cheol Choe; Korean J Pathol. 2002;36(4):266-270.

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Abstract PDF: Strongyloides stercoralis hyperinfection in immunocompromised patients is difficult to control due to delayed diagnosis, especially in nonendemic areas. A 70-year-old diabetic woman came in with an intermittent diarrhea. She received massive steroid therapy for a week under the impression of idiopathic gastrointestinal eosinophilic syndrome. Diagnosis of strongyloidiasis was made by demonstration of filariform larvae in two repeated sputum specimens two months later. Despite massive administration of albendazole, she died of diabetic ketoacidosis and septic shock. Autopsy revealed a diffusely thickened bowel wall, superimposed invasive pulmonary aspergillosis and the near total destruction of the lungs. Filariform larvae were detected only in the cutaneous lesions. It was presumed that Strongyloides stercoralis hyperinfection was caused by autoinfection in the patient's immunosuppressed status. The present case has two clinical importances; first, intensive treatment with albendazole could erradicate parasites except for the skin but sepsis presumably occurred due to a hypersensitivity reaction against liberated endotoxins during the death of the parasites by the drug. Second, cutaneous parasitic lesion resists the intensive antihelminthic treatment in an immunocompromised host.

Two Cases of Strongyloidiasis Diagnosed by Colonoscopic Biopsy.: Sang Chul Nam, Man Hoon Han, Young Su Kim, Yoon Seup Kum, In Soo Suh, Han Ik Bae; Korean J Pathol. 2007;41(5):343-346.

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Abstract PDF: Strongyloides stercoralis is an intestinal nematode that is able to infect the host tissue and persist for many years through autoinfection, and it causes life-threatening hyperinfection in immunocompromised hosts. We report here on two cases of strongyloidiasis that were diagnosed by colonoscopic biopsy. One case was a 73-year-old woman who was hospitalized with complaints of melena. She was being treated with corticosteroid due to her asthma and rheumatoid arthritis. The other case was a 63-year-old man who suffered with abdominal discomfort and severe loss of body weight (18 kg) for 2 months. In both cases, colonoscopic examination revealed polyps and petechiae at the entire colon. Microscopically, a small illdefined granuloma with a longitudinally sectioned parasite was seen on the colonoscopic biopsy. Endoscopic examination was done after suspecting parasitic infestation. The gastric and duodenal mucosa showed numerous cross sections of adult worms, eggs and larvae that were developing in crypts. Even if such a patient is in an asymptomatic state, this illness must be treated due to the potential for fatal autoinfection.

Hyperinfection Syndrome with Strongyloides Stercoralis: Report of a case.: Soo Im Choi, Soon Won Hong, Kwang Gil Lee; Korean J Pathol. 1989;23(3):359-364.

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Abstract PDF: Strongyloides stercoralis is a nematodes and is prevalent in the tropical regions. In Korea, 6 cases have been reported in which the parasites were identified in feces. We report a case of hyperinfection syndrome with Strongyloides stercoralis confirmed in the tissue sections. A 52-year-old woman was admitted to the hospital because of generalized edema and weakness. She received steroid therapy for 30 years because of rheumatoid arthritis. One year ago, generalized edema and dyspnea were developed and she was diagnosed as minimal change nephrotic syndrome for which she received cyclosporin. On admission, she complained of generalized weakness and edema, multiple arthralgia and abdominal discomfort with nausea. The white-cell count was 14,600 without eosinophilia. A stool specimen was negative for occult blood, ova or parasites. Right lower quadrant abdominal pain and tenderness were developed, and the exploratory laparotomy was done under the impression of the acute appendicitis. An appendectomy with a biopsy of mesenteric lymph nodes was performed. From the 5th day after operation, the patient began to complain of the abdominal pain and constipation. Under the impression of adhesion bad formation, the laparotomy was done and disclosed that the proximal ileum was markedly dilated. On jejunotomy, a great amount of formed stool and barium was noticed in the proximal portion of small bowel. The jejunal tissue was biopsied. Grossly, the appendix was unremarkable. Microscopically, the inflammatory reaction was nearly absent, but in serosa, minute granulomas were found which contain a part of the parasite. Same feature was noted in the mesenteric lymph node. The biopsied jejunum contains numerous adult female, filariform and rhabdidiform larvae and eggs in the mucosa, submucosa and muscle wall. Their morphology was compatible with Strongyloides stercoralis. The patient died 5 days later in the state of multiple organ failure.

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