Protein Loosing Enteropathy Secondary to Strongyloidiasis: Case Report and Review of the Literature

Abstract

Strongyloidiasis is a helminthic disease which affects millions around the world resulting in a significant burden in certain high risk groups. It is rarely reported in the Lebanese population probably due to the low index of suspicion in common practice. We are reporting a case of strongyloidiasis that was found in an elderly patient presenting initially with dyspnea followed by skin rash, protein loosing enteropathy, diarrhea, and abdominal pain while on corticosteroid therapy. The diagnosis was suspected based on clinical presentation in addition to peripheral eosinophilia. We will also describe the upper and lower endoscopic aspects of the disease, as well as histologic findings on duodenal and colonic biopsies.

Figure 1

Chest CT scan done during the first admission showing bilateral patchy asymmetric interstitial lung disease suspicious of allergic alveolitis or eosinophilic pneumonitis.

Figure 2

Duodenal bulb showing edematous nodular mucosa with erythematous spot.

Figure 3

Second duodenum showing edematous mucosa with erosions and white villi.

Figure 4

Cecal base showing patchy erythematous and petechial mucosa predominantly over the Ileocecal valve.

Figure 5

Terminal Ileum showing patchy erythematous lesions.

Figure 6

Duodenal biopsy showing preserved villi with dystrophic glands, multiple ulcerations, and eosinophilic infiltration. Parasitic larvae are also seen either superficial or encrusted into the mucosa compatible with strongyloidiasis.