A 50-year-old Central American male presented with two months of persistent nausea, weight loss, epigastric abdominal pain, and fluctuating diarrhea-constipation. Medical history was significant for HIV/AIDS and stage-IV Diffuse large B-cell lymphoma. On physical examination, the patient appeared cachectic with temporal wasting and had epigastric tenderness without rebound. Laboratory evaluation revealed 2,400 leukocytes/μL with 33% eosinophils, HIV-RNA viral load 20 copies/ml, CD4 count 50 cells/mm3, and C-reactive protein 44.3 mg/l. Esophagogastroduodenoscopy demonstrated gastric mucosal atrophy with patchy gastric antral nodularity (Figure 1). Histologic examination of gastric biopsies revealed gastric antral mucosal invasion, with Strongyloides stercoralis colonizing acini (Figure 2,3). Stool testing revealed Strongyloides filariform larvae confirming hyperinfection (Supplemental Video 1). Treatment with daily oral ivermectin 200 μg/kg for 2 weeks led to clinical improvement and parasitic elimination on stool examination. Strongyloidiasis is typically asymptomatic but can present with gastrointestinal symptoms during the enteric phase of parasitic development and maturation. Hyperinfection, stemming from accelerated autoinfection, especially in immunocompromised states, has increased larvae numbers in stool and is fatal in up to 90% patients. Strongyloidiasis most commonly affects duodenum and jejunum but can involve any portion of the gastrointestinal tract. Involvement of the stomach is rare but can lead to life-threatening complications.
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Acknowledgments/Assistance:
This work was supported by the Intramural Research Programs of National Institute of Diabetes, and Digestive and Kidney Diseases (NIDDK).
Abbreviations:
- CD4
Cluster of DIfferentiation 4
- HIV/AIDS
Human immunodeficiency virus/ Acquired immune deficiency syndrome
- RNA
Ribonucleic acid
Footnotes
Disclosures: None
Conflicts of Interest: None
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Data Availability Statement
All data provided is from a study approved by the Internal Review Board of the National Institutes of Health and is available to other researchers.