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http://dx.doi.org/10.3347/kjp.2015.53.2.223

Strongyloidiasis in a Diabetic Patient Accompanied by Gastrointestinal Stromal Tumor: Cause of Eosinophilia Unresponsive to Steroid Therapy  

Won, Eun Jeong (Department of Laboratory Medicine, Chonnam National University Hospital)
Jeon, Jin (Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Medical School)
Koh, Young-Il (Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Medical School)
Ryang, Dong Wook (Department of Laboratory Medicine, Chonnam National University Hospital)
Publication Information
Parasites, Hosts and Diseases / v.53, no.2, 2015 , pp. 223-226 More about this Journal
Abstract
We report here a case of strongyloidiasis in a 72-year-old diabetic patient (woman) accompanied by gastrointestinal stromal tumor receiving imatinib therapy, first diagnosed as hypereosinophilic syndrome and treated with steroids for uncontrolled eosinophilia. She suffered from lower back pain and intermittent abdominal discomfort with nausea and diagnosed with gastrointestinal stromal tumor. After post-operative imatinib treatment eosinophilia persisted, so that steroid therapy was started under an impression of hypereosinophilic syndrome. In spite of 6 months steroid therapy, eosinophilia persisted. Stool examination was performed to rule out intestinal helminth infections. Rhabditoid larvae of Strongyloides stercoralis were detected and the patient was diagnosed as strongyloidiasis. This diagnosis was confirmed again by PCR. The patient was treated with albendazole for 14 days and her abdominal pain and diarrhea improved. This case highlights the need for thorough investigation, including molecular approaches, to test for strongyloidiasis before and during steroid therapies.
Keywords
Strongyloides stercoralis; imatinib; gastrointestinal stromal tumor (GIST); PCR; hypereosinophilic syndrome;
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Times Cited By KSCI : 4  (Citation Analysis)
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1 Olsen A, van Lieshout L, Marti H, Polderman T, Polman K, Steinmann P, Stothard R, Thybo S, Verweij JJ, Magnussen P. Strongyloidiasis-the most neglected of the neglected tropical diseases? Trans R Soc Trop Med Hyg 2009; 103: 967-972.   DOI
2 Schar F, Trostdorf U, Giardina F, Khieu V, Muth S, Marti H, Vounatsou P, Odermatt P. Strongyloides stercoralis: global distribution and risk factors. PLoS Negl Trop Dis 2013; 7: e2288.   DOI
3 Potter A, Stephens D, De Keulenaer B. Strongyloides hyperinfection: a case for awareness. Ann Trop Med Parasitol 2003; 97: 855-860.   DOI
4 Keiser PB, Nutman TB. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 2004; 17:208-217.   DOI
5 Requena-Mendez A, Chiodini P, Bisoffi Z, Buonfrate D, Gotuzzo E, Munoz J. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoS Negl Trop Dis 2013; 7: e2002.   DOI
6 Gonzalez A, Gallo M, Valls ME, Munoz J, Puyol L, Pinazo MJ, Mas J, Gascon J. Clinical and epidemiological features of 33 imported Strongyloides stercoralis infections. Trans R Soc Trop Med Hyg 2010; 104: 613-616.   DOI
7 Rothenberg ME. Eosinophilia. N Engl J Med 1998; 338: 1592-1600.   DOI
8 Schaller JL, Burkland GA. Case report: rapid and complete control of idiopathic hypereosinophilia with imatinib mesylate. MedGenMed 2001; 3: 9.
9 Choi SI, Hong SW, Lee KG. Hyperinfection syndrome with Stron gyloides stercoralis: report of a case. Korean J Pathol 1989; 23: 359-364.
10 Lee SK, Shin BM, Khang SK, Chai JY, Kook J, Hong ST, Lee SH. Nine cases of strongyloidiasis in Korea. Korean J Parasitol 1994; 32: 49-52.   DOI
11 Kim J, Joo HS, Kim DH, Lim H, Kang YH, Kim MS. A case of gastric strongyloidiasis in a Korean patient. Korean J Parasitol 2003; 41: 63-67.   DOI
12 Kim J, Joo HS, Ko HM, Na MS, Hwang SH, Im JC. A case of fatal hyperinfective strongyloidiasis with discovery of autoinfective filariform larvae in sputum. Korean J Parasitol 2005; 43: 51-55.   DOI
13 Devault GAJ, King JW, Rohr MS, Landreneau MD, Brown ST, McDonald JC. Opportunistic infections with Strongyloides stercoralis in renal transplantation. Rev Infect Dis 1990; 12: 653-671.   DOI
14 Kim HO, Kim JH, Cheon YH, Suh YS, Lim MH, Heo ST, Sohn WM, Ko GH, Bae IG. A case of duodenal ulcer due to coinfection with Strongyloides stericoralis and cytomegalovirus. Infect Chemother 2010; 42: 431-433.   DOI
15 Cho JY, Kwon JG, Ha KH, Oh JY, Jin MI, Heo SW, Lee GH, Cho CH. A case of steroid-induced hyperinfective strongyloidiasis with bacterial meningitis. Korean J Gastroenterol 2012; 60: 330-334.   DOI
16 Genta RM, Miles P, Fields K. Opportunistic Strongyloides stercoralis infection in lymphoma patients. Report of a case and review of the literature. Cancer 1989; 63: 1407-1411.   DOI
17 Gotuzzo E, Terashima A, Alvarez H, Tello R, Infante R, Watts DM, Freedman DO. Strongyloides stercoralis hyperinfection associated with human T-cell lymphotropic virus type-1 infection in Peru. Am J Trop Med Hyg 1999; 60: 146-149.   DOI
18 Sethi S, Kheraj R, Sethi N, Wadhwa V. A case of strongyloidiasis presenting as a colonic mass. Am J Gastroenterol 2014; 109: 20.   DOI
19 Moghaddassani H, Mirhendi H, Hosseini M, Rokni M, Mowlavi G, Kia E. Molecular diagnosis of Strongyloides stercoralis infection by PCR detection of specific DNA in human stool samples. Iran J Parasitol 2011; 6: 23-30.
20 Nishida T, Doi T, Naito Y. Tyrosine kinase inhibitors in the treatment of unresectable or metastatic gastrointestinal stromal tumors. Expert Opin Pharmacother 2014; 15: 1979-1989.   DOI
21 Anderson NW, Klein DM, Dornink SM, Jespersen DJ, Kubofcik J, Nutman TB, Merrigan SD, Couturier MR, Theel ES. Comparison of three immunoassays for detection of antibodies to Strongyloides stercoralis. Clin Vaccine Immunol 2014; 21: 732-736.   DOI
22 Fazel R, Dhaliwal G, Saint S, Nallamothu BK. Clinical problem-solving. A red flag. N Engl J Med 2009; 360: 2005-2010.   DOI
23 Vandenberg O, Van Laethem Y, Souayah H, Kutane WT, van Gool T, Dediste A. Improvement of routine diagnosis of intestinal parasites with multiple sampling and SAF-fixative in the triple-faeces-test. Acta Gastroenterol Belg 2006; 69: 361-366.
24 Bruijnesteijn van Coppenraet LE, Wallinga JA, Ruijs GJ, Bruins MJ, Verweij JJ. Parasitological diagnosis combining an internally controlled real-time PCR assay for the detection of four protozoa in stool samples with a testing algorithm for microscopy. Clin Microbiol Infect 2009; 15: 869-874.   DOI
25 Santos RB, Fonseca LE Jr, Santana AT, Silva CA, Guedes JC. Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy. Arq Gastroenterol 2011; 48: 225-230.   DOI
26 Sultana Y, Jeoffreys N, Watts MR, Gilbert GL, Lee R. Real-time polymerase chain reaction for detection of Strongyloides stercoralis in stool. Am J Trop Med Hyg 2013; 88: 1048-1051.   DOI