Year 2016 / Volume 108 / Number 8
Case Report
IBD or strongyloidiasis?

516-520

DOI: 10.17235/reed.2015.3847/2015

Marta Maia Boscá Watts, Andrea Marco Marqués, Ester Savall-Núñez, Ana Artero-Fullana, Bernardo Lanza Reynolds, Verónica Andrade Gamarra, Víctor Puglia Santos, Octavio Burgués Gasión, Francisco Mora Miguel,

Abstract
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.
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References
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8. Khanna S, Sedlack RE, Mangan TF. An unusual case of SIADH. Gastroenterol Hepatol Clinical Case Studies 2011;7:191-3.
9. Hayashi E, Ohta N, Yamamoto H. Case report: Syndrome of Inappropriate Secretion of Antidiuretic Hormone Associated with Strongyloidiasis. Southeast Asian J.Trop.Med.Public Health 2007; 38: 239-46.
10. Buonfrate D, Requena-Mendez A, Angheben A, et al. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis. 2013;13:78. doi: 10.1186/1471-2334-13-78.
11. Greenstein RJ, Su L, Haroutunian V, et al. On the action of methotrexate and 6-mercaptopurine on M. avium subspecies paratuberculosis. PLoS One. 2007;2:e161. doi: 10.1371/journal.pone.0000161
12. Bosca-Watts MM, Tosca J, Anton R, et al. Pathogenesis of Crohn’s disease: Bug or no bug. World J Gastrointest Pathophysiol.2015;6:1-12. doi: 10.4291/wjgp.v6.i1.1.
13. Ditgen D, Anandarajah EM, Meissner KA, et al. Harnessing the helminth secretome for therapeutic immunomodulators. Biomed Res Int. 2014;2014:964350. doi: 10.1155/2014/964350.
14. Erb KJ. Can helminths or helminth-derived products be used in humans to prevent or treat allergic diseases? Trends Immunol 2009;30:75–82. doi: 10.1016/j.it.2008.11.005
15. Khan AR, Fallon PG. Helminth therapies: translating the unknown unknowns to known knowns. Int J Parasitol, 2013; 43 : 293–9. doi: 10.1016/j.ijpara.2012.12.002
1. Moghadam KG, Khashayar P, Hashemi M. Gastrointestinal strongyloidiasis in immunocompromised patients: a case report. Acta Med Indones. 2011;43:191-4.
2. Ben-Horin S, Barshack I, Chowers Y, et al. Flare-up of ulcerative colitis after systemic corticosteroids: A strong case for Strongyloides. World J Gastroenterol 2008; 14: 4413-5. doi: 10.3748/wjg.14.4413
3. Ghosh K, Ghosh K. Strongyloides stercoralis septicaemia following steroid therapy for eosinophilia: report of three cases. Trans R Soc Trop Med Hyg. 2007;101:1163. doi: 10.1016/j.trstmh.2007.05.021
4. Farthing M, Fedail S, Savioli L, et al. WGO Practice Guideline Management of Strongyloidiasis Octobre 2004
5. P J Smith, B Theis, N R O'Shea, et al. Inflammatory bowel disease III: PWE-235 Screening using the European Crohn's and Colitis Organisation (ECCO) guidelines demonstrates high strongyloides sero-prevalence in migrants with inflammatory bowel disease. Gut 2012;61:Suppl 2 A393-4. doi:10.1136/gutjnl-2012-302514d.235
6. Gutierrez Y, Bhatia P, Garbadawala ST, et al. Strongyloides stercoralis eosinophilic granulomatous enterocolitis. Am J Surg Pathol 1996; 20: 603-12. DOI: 10.1097/00000478-199605000-00007
7. Corsetti M, Basilisco G, Pometta R, et al. Mistaken diagnosis of eosinophilic colitis. Ital J Gastroenterol Hepatol 1999; 31: 607-9
8. Khanna S, Sedlack RE, Mangan TF. An unusual case of SIADH. Gastroenterol Hepatol Clinical Case Studies 2011;7:191-3.
9. Hayashi E, Ohta N, Yamamoto H. Case report: Syndrome of Inappropriate Secretion of Antidiuretic Hormone Associated with Strongyloidiasis. Southeast Asian J.Trop.Med.Public Health 2007; 38: 239-46.
10. Buonfrate D, Requena-Mendez A, Angheben A, et al. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis. 2013;13:78. doi: 10.1186/1471-2334-13-78.
11. Greenstein RJ, Su L, Haroutunian V, et al. On the action of methotrexate and 6-mercaptopurine on M. avium subspecies paratuberculosis. PLoS One. 2007;2:e161. doi: 10.1371/journal.pone.0000161
12. Bosca-Watts MM, Tosca J, Anton R, et al. Pathogenesis of Crohn’s disease: Bug or no bug. World J Gastrointest Pathophysiol.2015;6:1-12. doi: 10.4291/wjgp.v6.i1.1.
13. Ditgen D, Anandarajah EM, Meissner KA, et al. Harnessing the helminth secretome for therapeutic immunomodulators. Biomed Res Int. 2014;2014:964350. doi: 10.1155/2014/964350.
14. Erb KJ. Can helminths or helminth-derived products be used in humans to prevent or treat allergic diseases? Trends Immunol 2009;30:75–82. doi: 10.1016/j.it.2008.11.005
15. Khan AR, Fallon PG. Helminth therapies: translating the unknown unknowns to known knowns. Int J Parasitol, 2013; 43 : 293–9. doi: 10.1016/j.ijpara.2012.12.002
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Boscá Watts M, Marco Marqués A, Savall-Núñez E, Artero-Fullana A, Lanza Reynolds B, Andrade Gamarra V, et all. IBD or strongyloidiasis?. 3847/2015


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Publication history

Received: 14/05/2015

Accepted: 01/07/2015

Online First: 04/12/2015

Published: 29/07/2016

Article revision time: 22 days

Article Online First time: 204 days

Article editing time: 442 days


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