ABSTRACT
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Subject(s)
Humans , Female , Aged , Immunoglobulin G4-Related Disease/diagnostic imaging , Cholangiocarcinoma/diagnostic imaging , Enzyme Therapy , Cholangiocarcinoma/drug therapy , Tomography, X-Ray Computed , Pancreas/diagnostic imaging , Pancreas/pathology , Cholestasis/complications , Cholangiopancreatography, Magnetic Resonance/methodsSubject(s)
Bile Duct Neoplasms/diagnosis , Bile Ducts/diagnostic imaging , Cholangiocarcinoma/diagnosis , Cholangitis, Sclerosing/diagnostic imaging , Endoscopy, Digestive System/methods , Immunoglobulin G4-Related Disease/diagnostic imaging , Aged , Anti-Inflammatory Agents/therapeutic use , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Cholangitis, Sclerosing/diagnosis , Cholangitis, Sclerosing/drug therapy , Common Bile Duct/diagnostic imaging , Diagnosis, Differential , Exocrine Pancreatic Insufficiency/complications , Humans , Immunoglobulin G4-Related Disease/diagnosis , Immunoglobulin G4-Related Disease/drug therapy , Male , Prednisone/therapeutic use , Remission Induction , Signal Processing, Computer-AssistedABSTRACT
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Subject(s)
Humans , Male , Child , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/surgery , Gastroscopy/instrumentation , Gastrointestinal Diseases/diagnostic imaging , Gastrointestinal Transit , Duodenum/diagnostic imaging , Duodenum/surgeryABSTRACT
Introduction: Strongyloides has been shown to infrequently mimic inflammatory bowel disease (IBD) or to disseminate when a patient with IBD and unrecognized strongyloides is treated with immunosupression. Case report: A man from Ecuador, living in Spain for years, with a history of type 2 diabetes mellitus and psoriasis treated with topical corticosteroids, was admitted to the hospital with an 8-month history of diarrhoea. Blood tests showed hyperglycemia, hyponatremia, elevated CRP and faecal calprotectin. Colonoscopy suggested IBD. The patient improved with steroids, pending biopsy results, and he was discharged. Biopies were compatible with IBD, but careful examination revealed strongyloides. He was given a prescription of albendazole. He had to be readmitted due to SIADH, which resolved with fluid restriction. Upon discharge albendazole was prescribed again. The patient skipped most of the out-patientclinic visits. He returned a year later on 10 mg/week methotrexate, asymptomatic, with 20% eosinophilia, and admitting he had never taken the strongyloides treatment for economical reasons. He then received a week of oral albendazol at the hospital. Biopsies and blood cell count were afterwards normal (eosinophils 3.1%) and serology for strongyloides antibodies was negative. Discussion: This case is of interest for four rarely concurring reasons. It´s a worm infection that mimics IBD; the infection was diagnosed by colon biopsy; the infection caused a SIADH; and, most interestingly, even though the patient is on immunosupression, he remains asymptomatic (AU)
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Subject(s)
Humans , Male , Adult , Strongyloidiasis/complications , Strongyloidiasis , Hyperglycemia/complications , Colonoscopy/methods , Albendazole/therapeutic use , Immunosuppression Therapy/methods , Immunosuppression Therapy , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases , Hyponatremia/complications , Steroids/therapeutic use , Methotrexate/therapeutic use , Eosinophilia/complications , Strongyloides stercoralis , Strongyloides stercoralis/isolation & purification , BiopsyABSTRACT
INTRODUCTION: Strongyloides has been shown to infrequently mimic inflammatory bowel disease (IBD) or to disseminate when a patient with IBD and unrecognized strongyloides is treated with immunosupression. CASE REPORT: A man from Ecuador, living in Spain for years, with a history of type 2 diabetes mellitus and psoriasis treated with topical corticosteroids, was admitted to the hospital with an 8-month history of diarrhoea. Blood tests showed hyperglycemia, hyponatremia, elevated CRP and faecal calprotectin. Colonoscopy suggested IBD. The patient improved with steroids, pending biopsy results, and he was discharged. Biopies were compatible with IBD, but careful examination revealed strongyloides. He was given a prescription of albendazole. He had to be readmitted due to SIADH, which resolved with fluid restriction. Upon discharge albendazole was prescribed again. The patient skipped most of the out-patient-clinic visits. He returned a year later on 10 mg/week methotrexate, asymptomatic, with 20% eosinophilia, and admitting he had never taken the strongyloides treatment for economical reasons. He then received a week of oral albendazol at the hospital. Biopsies and blood cell count were afterwards normal (eosinophils 3.1%) and serology for strongyloides antibodies was negative. DISCUSSION: This case is of interest for four rarely concurring reasons. It´s a worm infection that mimics IBD; the infection was diagnosed by colon biopsy; the infection caused a SIADH; and, most interestingly, even though the patient is on immunosupression, he remains asymptomatic.
Subject(s)
Inflammatory Bowel Diseases/diagnosis , Strongyloidiasis/diagnosis , Adult , Albendazole/therapeutic use , Anthelmintics/therapeutic use , Diagnosis, Differential , Humans , Immunosuppressive Agents/therapeutic use , Inappropriate ADH Syndrome/complications , Inflammatory Bowel Diseases/drug therapy , Inflammatory Bowel Diseases/parasitology , Male , Strongyloidiasis/drug therapy , Strongyloidiasis/parasitologyABSTRACT
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