Strongyloides colitis is an often misdiagnosed lethal infection that resembles ulcerative colitis: first case of colon perforation in an adult

Rancaño, Rocío Santos; Santacruz, Carlos Cerdán; Morales, Mariela Delgado; Pérez, Emilio Buendía; Bumedien, Fuad; Bueno, Víctor Manuel Sánchez; Zapata, Inés Pérez; Guillén, Ramón Alonso

doi:10.1111/ans.16370

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…In our patient, IBD was ruled out from histopathology. This distinction is important, as three case reports misidentified Strongyloides colitis by initially treating a patient with immunosuppressive therapy on a presumptive diagnosis of IBD, leading to hyperinfection, severe sepsis, and death [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Lethal Strongyloides stercoralis‐Associated Chronic Fulminant Colitis in an Immunocompetent Patient

Choi,

Kulkarni,

Shanmugalingam

et al. 2024

Case Reports in Infectious Diseases

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A 70‐year‐old immunocompetent Lebanese male presented with 3‐month history of watery diarrhoea and abdominal pain after recently arriving to Australia from Lebanon. He had a colectomy for an iatrogenic bowel perforation associated with a colonoscopy in Lebanon several months prior. His computed tomography (CT) scan demonstrated pancolitis. Stool culture and polymerase chain reaction (PCR) were positive for Strongyloides stercoralis. Despite Strongyloides treatment and total parenteral nutrition, his pancolitis unexpectedly persisted despite negative stool cultures, and the patient failed to progress over several weeks with worsening abdominal pain. A colectomy was considered. However, due to his recent myocardial infarct requiring cardiac stenting, his anticoagulant and antiplatelets could not be ceased for at least 3 months without significant cardiac risk. After hospitalisation for several weeks in Australia, he was discharged against medical advice and flew back to Lebanon, where he presented with worsening pain and underwent a subtotal colectomy. Unfortunately, he developed multiorgan failure and died 3 weeks following his colectomy. Strongyloides‐related pancolitis is a rare condition in immunocompetent adults that has the potential to persist and be lethal, despite microbiological antiparasitic eradication.

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Section: Discussionmentioning

confidence: 99%

An Unusual Case of Lethal Strongyloides stercoralis‐Associated Chronic Fulminant Colitis in an Immunocompetent Patient

Choi,

Kulkarni,

Shanmugalingam

et al. 2024

Case Reports in Infectious Diseases

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Strongyloides colitis, a rare but important mimic of Crohn’s disease, resulting in coma and multi-organ failure: a case report

et al. 2022

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Background Strongyloides colitis is a severe form of strongyloidiasis that carries a high mortality rate if untreated. There is an overlapping clinical presentation between Strongyloides colitis and Crohn’s disease. Here, we present a case of a patient who was diagnosed with Crohn’s disease and was treated with immunosuppressant therapy which resulted in a poor outcome. Case presentation A middle-aged, native African male presented with diarrhea, abdominal pain, and weight loss. Colonoscopy showed some patchy inflammation in the caecum, which on biopsy was suggestive of Crohn’s disease. He had a short course of steroids before being admitted to an emergency with abdominal pain, diarrhea, malnutrition, and severe weight loss. Initial conservative treatment failed, and he became acutely unwell and septic with peritonitis. Laparotomy was carried out, which showed mild inflammation in the terminal ileum, which was not resected. Postoperatively, the patient became comatose and went into multi-organ dysfunction. He failed to progress, and a further laparotomy and subtotal colectomy were performed on the 12th postoperative day. His multi-organ failure progressed, and he succumbed to death 4 days later. Discussion Strongyloides stercoralis is a parasite causing an enteric infection in animals and humans. Strongyloidiasis in immunocompetent individuals is usually an indolent disease. However, in immunocompromised individuals, it can cause hyperinfective syndrome. Patients with strongyloid colitis should undergo colonoscopy and biopsy where acute inflammation with eosinophilic infiltrates indicates parasitic infiltration of the colonic wall. Surgery is generally not indicated, and any surgical intervention with misdiagnosis of a flare-up of IBD can be very detrimental to the patient. Conclusion Strongyloid colitis can very harmfully mimic Crohn’s colitis, and the use of steroids and immunosuppressants can disseminate parasitic infection. Hyperinfection syndrome can lead to sepsis, organ dysfunction, and comma. Disseminated infection carries a high mortality.

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Strongyloides colitis is an often misdiagnosed lethal infection that resembles ulcerative colitis: first case of colon perforation in an adult

Cited by 2 publications

References 8 publications

An Unusual Case of Lethal Strongyloides stercoralis‐Associated Chronic Fulminant Colitis in an Immunocompetent Patient

An Unusual Case of Lethal Strongyloides stercoralis‐Associated Chronic Fulminant Colitis in an Immunocompetent Patient

Strongyloides colitis, a rare but important mimic of Crohn’s disease, resulting in coma and multi-organ failure: a case report

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