A Rare Intestinal Manifestation in a Patient with Common Variable Immunodeficiency and Strongyloidiasis

Abstract

We report an immunodeficient patient with a rare gastrointestinal manifestation. A 26-year-old male with common variable immunodeficiency (CVID) and bronchiolitis obliterans, who was on intravenous γ-globulin and prednisone, presented diffuse abdominal pain, nausea, vomiting and constipation of 3 days’ duration. He reported 5 years of recurrent respiratory infections and diarrhea with negative stool tests, including tests for Strongyloides stercoralis. A physical exam revealed a poor general condition, anemia, dehydration and a distended painful abdomen with guarding, without abdominal sounds. The radiological study showed marked dilation of the small bowel that was edematous. Resection of the affected loop was performed and the histopathologic study showed transmural infection with S. stercoralis and hemorrhagic necrosis of the muscular layer, without mucosal destruction. The patient developed malabsorption syndrome and septic shock; he was treated with antibiotics and thiabendazole and was finally discharged in a good general condition. CVID is a rare disease and its association with systemic strongyloidiasis is very uncommon, but it has been reported in patients on corticosteroids. Hemorrhagic necrosis of the muscular layer without mucosal destruction was not found in the literature studied.

Disseminated strongyloides infection with Enterobius vermicularis and Streptococcus faecalis in an immunocompetent teenage UK resident

“…Severe abdominal pain has been well documented with strongyloides and enterobiasis [5,6,14,16] and is possibly caused by a high nematode load. Several case reports that document stongyloides infection presenting as an acute abdomen, appendicitis and non-specific abdominal pain comment on the presence of a high nematode load [5,7] There is some literature reporting invasive E. vermicularis infection [16][17][18].…”

“…Immunodeficiency and immune reconstitution syndromes are reported to result in severe infection and hyperinfection [6,8]. Many cases report unmasking of asymptomatic chronic strongyloides infection by onset of immunodeficiency (iatrogenic, most reported with corticosteroids or a disease process); this was not the case [12].…”

“…Both Enterobius vermicularis and urinary tract infections are common in the UK. Many reports in the literature document the unusual presentation of strongyloides when masked by other illnesses [3][4][5][6][7][8]. The contribution of these diagnoses to her clinical presentation is discussed.…”

Overview of Strongyloidiasis: A Neglected Tropical Disease

“…They have a short buccal cavity with a long slender esophagus and have prominent genital primordial. The filariform larvae are the non-feeding stage, they have a longer esophagus and more of a notched tail than the rhabditiform larvae stage (Bianchi et al, 2006). Usually, only the females are found in the intestinal track because of the asexual reproduction therefore, the morphology of male larvae is not significant in a clinical setting (Table 1).…”

“…Larvae in the soil infect the human host by penetration of intact skin to begin the parasitic cycle (Bianchi et al, 2006). Autoinfection is one of the important characteristic features of the life cycle of S. stercoralis.…”