<i>Strongyloides stercoralis</i> Infection Causing Obstructive Jaundice and Refractory Pancreatitis: A Lesson Learned from a Case Study

Abstract

A 58-year-old Japanese woman came to our institution because of leg edema and abdominal distention. She had developed acute pancreatitis 5 times in the past 3 years. Dilation of the bile duct and main pancreatic duct without obstruction was observed on computed tomography and magnetic resonance cholangiopancreatography. The presence of Strongyloides stercoralis was highly suspected from the biopsy sample from the duodenal papilla. Polymerase chain reaction amplification and sequencing of small subunit rDNA from paraffin-embedded specimens identified the worm as S. stercoralis. All of the symptoms were considered to be associated with S. stercoralis infection. Therefore, the patient was treated with oral administration of ivermectin. Subsequently, symptoms and laboratory data improved. There has been no recurrence of the symptoms to date.

Strongyloidiasis Infection As the Cause of Pancreatitis

“…Like in Machado-Filho et al, our patient had CA 19-9 elevation, and this can be explained due to involvement of the duodenal ampulla and pancreatic duct [11]. Per the available literature, treatment does not seem to be different for this condition [9][10][11]. In retrospect, the EUS and ERCP could be showing S. stercoralis larvae as the cause of obstruction in this case.…”

“…Strongyloides pancreatitis is an extremely rare complication that has been reported in a handful of cases, around 5-7 in the English and Spanish literature [9][10][11]. The theorized mechanism for pancreatitis is inflammation of the duodenal ampulla and pancreatic duct and rarely leads to pancreatic duct dilation [9][10].…”

“…Strongyloides pancreatitis is an extremely rare complication that has been reported in a handful of cases, around 5-7 in the English and Spanish literature [9][10][11]. The theorized mechanism for pancreatitis is inflammation of the duodenal ampulla and pancreatic duct and rarely leads to pancreatic duct dilation [9][10]. Like in Machado-Filho et al, our patient had CA 19-9 elevation, and this can be explained due to involvement of the duodenal ampulla and pancreatic duct [11].…”

Status of Strongyloidiasis in Japan, 2000–2017

“…22 Despite these effective preventative measures by the government, infections with S. stercoralis have still been reported in the Okinawa and Kagoshima prefectures. [23][24][25] Okinawa has a high infection rate of human T-cell lymphotropic virus type 1 (HTLV-1), a virus associated with adult T-cell leukemia/lymphoma, and a close relationship between S. stercoralis and HTLV-1 infections has been reported. 26 Human T-cell lymphotropic virus type 1 is an important cofactor in accelerated autoinfection which causes severe form of strongyloidiasis.…”

Biliary Strongyloides stercoralis With Cholecystitis and Extensive Portal Vein Thrombosis

“…We propose that entry of S. stercoralis rhabditiform larvae into the patient’s gallbladder precipitated cholecystitis with inflammation, leading to portal vein thrombosis and other associated findings. Parasite burden in the duodenum has been reported to produce inflammation of the ampulla, papillitis, and subsequent biliary dilation with cholangitis, cholecystitis, and/or pancreatitis [ 3 , 5 , 7 ]. This mechanism did not underlie the presentation of this patient as duodenal inflammation and papillitis were not apparent on ERCP.…”