Case Report: Duodenal Papillary Stenosis Secondary to Strongyloides stercoralis Infection in a Non-Immunocompromised Host

Abstract

Strongyloides stercoralis infection is a common infection in tropical and subtropical regions and is considered one of the "neglected tropical diseases." Owing to its life cycle, this infection can remain undetectable for years, preventing an early diagnosis and prompt treatment. We report the case of a 65-year-old woman who presented to us with a history of nausea, abdominal pain, bloating, and weight loss and, after initial radiologic and laboratory workup, was diagnosed with a periampullary mass with no secondary spread. She underwent an uneventful pylorus-preserving pancreatoduodenectomy, and on histopathological study of the lesion, a diagnosis of S. stercoralis infection was confirmed. This case stands out because of the importance of keeping S. stercoralis infections as a differential diagnosis of periampullary masses, particularly when the patient comes from regions where S. stercoralis is prevalent.

Figure 1.

Coronal abdominal T2-weighted magnetic resonance cholangiopancreatography demonstrating extrahepatic bile duct (star) and pancreatic (arrow) dilation.

Figure 2.

Photographs from the histopathological study of the resected duodenum. (A and B) Usual intestinal epithelium, with massive submucosal and muscular inflammatory infiltrates, mainly neutrophils and plasmocytes. Stars show plenty of Strongyloides stercoralis specimens lodging in the duodenal crypts.