Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease.
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| Abstract |
A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia/melena requiring > 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 am cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of Strongyloides stercoralis, indicating Strongyloides hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection.
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| Authors | Brittany Yee, Nai-Wen Chi, Lawrence A Hansen, Roland R Lee, Hoi-Sang U, Thomas J Savides, Joseph M Vinetz |
| Journal | The American journal of tropical medicine and hygiene (Am J Trop Med Hyg) Vol. 93 Issue 4 Pg. 822-7 (Oct 2015) ISSN: 1476-1645 [Electronic] United States |
| PMID | 26195463 (Publication Type: Case Reports, Journal Article) |
| Copyright | © The American Society of Tropical Medicine and Hygiene. |
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