ABSTRACT
Strongyloidiasis, although uncommon in comparison with other major intestine nematodes, is widely distributed in the tropics and subtropics. Infection is acquired most commonly when infective larvae in soil come in contact with skin. Strongyloides stercoralis is unique among intestinal nematodes because of its ability to cause hyperinfection syndrome in the immunosuppressed host. Adult worms inhabit the upper small intestine, were the females burrow through the mucosa. Females deposit ova, which hatch into larvae. These organisms bore through the intestinal epithelium to the gut lumen and are passed with feces. Larvae in the outside environment can either molt and differentiate into free-living adult male and female worms. After penetration of skin or gut mucosa, larvae pass thourgh the circulation to the lungs, break into the alveolar spaces, ascend the trachea and are then swallowed to their final residence in the small bowel. massive larvae invasion of the lungs and other organs may occur, especially in immunocompromised patients. Over one third of patients infected with S. stercoralis have no symptoms. Local cutaneous manifestations include a pruritic, erythematous papular rush at the site of larvae penetration. With pulmonary migration of larvae, a Loffer's syndrome (transient, spontaneously resolving pulmonary infiltrates with peripheral blood eosinophilia, associated with a drug reaction or helminthic infestation) with cough, wheezing, pulmonary infiltration and eosinophilia can be observed. An illustrative female patient 46 years old with this pathology, is decribed and reported in the article.
Subject(s)
Female , Antiparasitic Agents , Duodenal Diseases , Pulmonary Eosinophilia/pathology , Host-Parasite Interactions , Infections , Strongyloides stercoralisABSTRACT
Metastases to the stomach from an extra-digestive neoplasm are an unusual event, identified in less than 2
of cancer patients at autopsy (between 1.7
). The stomach may be involved by hematogenous spread from a distant primary tumor (most commonly lung, breast and melanoma). Tumors of neighboring organs, such as esophagus, pancreas and gallbladder, may reach the stomach by continuity or by lymphatic-hematogenous spread. Endoscopic routine studies with biopsies have improved the diagnosis of this pathology. Nevertheless, in some cases the histologic study is a false negative because the neoplasia can be placed in the deepest layers of the stomach. We report the case of a 56-year-old man who presented a gastric metastasis of a high gradeuro thelial carcinoma of urinary bladder and we review the literature.