An indigenous case of intestinal capillariasis with protein-losing enteropathy in Korea

Abstract

We encountered an indigenous case of intestinal capillariasis with protein-losing enteropathy in the Republic of Korea. A 37-year-old man, residing in Sacheon-si, Gyeongsangnam-do, admitted to the Gyeongsang National University Hospital (GNUH) due to long-lasting diarrhea, abdominal pain, anasarca, and weight loss. He recalled that he frequently ate raw fish, especially the common blackish goby (Acanthogobius flavimanus) and has never been abroad. Under the suspicion of protein-losing enteropathy, he received various kinds of medical examinations, and was diagnosed as intestinal capillariasis based on characteristic sectional findings of nematode worms in the biopsied small intestine. Adults, juvenile worms, and eggs were also detected in the diarrheic stools collected before and after medication. The clinical symptoms became much better after treatment with albendazole 400 mg daily for 3 days, and all findings were in normal range in laboratory examinations performed after 1 month. The present study is the 6th Korean case of intestinal capillariasis and the 3rd indigenous one in the Republic of Korea.

Keywords: Capillaria philippinensis; indigenous case; intestinal capillariasis; protein-losing enteropathy.

Fig. 1

(A) Histopathologic findings, including atrophic intestinal villi, intense infiltration of plasma cells in the lamina propria, and sectioned worms (arrow marks), are seen in biopsy specimens of the small intestines. (B-D) Magnified views of sectioned worms. (B) A longitudinal section of an esophageal level with stichocytes. (C) Cross-section of the testis (T) level. (D) Cross-section of the uterus (U) level with sectioned larvae. All scale bar in µm.

Fig. 2

Adult worms and an egg of Capillaria philippinensis collected from the diarrheic stools of the patient. (A) Male worm, 1,872×28.0 µm in average size, showing the characteristically long esophagus with a chain of stichocytes and a long spicule within a sheath (arrow mark). Scale bar=200 µm. (B) Female worm, 2,556×35 µm in average size, having a long esophagus with a chain of stichocytes and a vulva opening (arrow mark) located posteriorly at about 42 µm from the esophago-intestinal junction. Scale bar=100 µm. (C) A mature egg, 43.3×20.4 µm in size, having characteristic mucoid plugs at both ends. Scale bar=10 µm.