Eosinophilic endocarditis and Strongyloides stercoralis.

A 40-year-old woman from El Salvador presented with 3 months of abdominal pain and diarrhea followed by 2 weeks of atypical chest pain and exertional dyspnea and was diagnosed with eosinophilic endocarditis secondary to Strongyloides stercoralis infection. Transthoracic echocardiogram revealed apical masses in the left and right ventricles and a thickened posterior mitral valve leaflet and cardiac magnetic resonance imaging confirmed the presence of a left ventricular apical mass with diffuse subendocardial delayed enhancement consistent with endocardial fibrosis. In conclusion, eosinophilic endocarditis is a rare cause of restrictive cardiomyopathy characterized by endomyocardial fibrosis and apical thrombosis and fibrosis with frequent involvement of the posterior mitral valve leaflet.

Eosinophilic acute appendicitis caused by Strongyloides stercoralis and Enterobius vermicularis in an HIV-positive patient.

A 29 year old female HIV-positive patient presented in emergency with acute right lower quadrant abdominal pain, fever, tenderness and positive Blumberg sign. Laboratorial tests revealed eosinophilia, anaemia and leukocytosis. She underwent exploratory laparotomy followed by appendectomy. The pathological analysis of the appendix revealed acute appendicitis, accentuated eosinophilia and infestation by Strongyloides stercoralis and Enterobius vermicularis. She did well after surgery and adequate treatment. To the authors' knowledge, this is the first case of eosinophilic acute appendicitis caused by these two parasitic worms reported in the medical literature.

Bilateral parotid abscesses as the initial presentation of strongyloidiasis in the immunocompetent host.

BACKGROUND: Most suppurative parotid abscesses are unilateral and result from bacterial infection via Stensen's duct. Formation of bilateral parotid abscesses rarely occur, and cases arising in the setting of parasite infection have not been described to date. METHODS AND RESULTS: A 41-year-old man presented with bilateral parotid abscesses and underwent incision and drainage of right-sided swelling because of poor response to the aspiration drainage and intravenous antibiotic therapy. A nematode larva, morphologically consistent with Strongyloides stercoralis (S. stercoralis), was found in the cytologic examination, and bilateral abscesses regressed significantly after administration of Ivermectin. CONCLUSION: We report the first case of S. stercoralis infection presenting as bilateral parotid abscesses. This case expands the spectrum of diseases associated with S. stercoralis and suggests that clinicians, especially in the endemic regions, should consider S. stercoralis infection in the differential diagnosis of refractory parotid abscess.

Gastric perforation caused by Strongyloides stercoralis: a case report.

Strongyloidiasis is a parasitosis caused by the female nematode of the Strongyloides stercoralis. S. stercoralis causes a chronic infection that is asymptomatic in 50% of chronically infected patients, and it can also affect the stomach. Gastric involvement causes symptoms mostly mimicking gastritis. We report herein a case of gastric perforation in a 37-year-old woman, which was thought to be caused by S. stercoralis.

A rare intestinal manifestation in a patient with common variable immunodeficiency and strongyloidiasis.

We report an immunodeficient patient with a rare gastrointestinal manifestation. A 26-year-old male with common variable immunodeficiency (CVID) and bronchiolitis obliterans, who was on intravenous gamma-globulin and prednisone, presented diffuse abdominal pain, nausea, vomiting and constipation of 3 days' duration. He reported 5 years of recurrent respiratory infections and diarrhea with negative stool tests, including tests for Strongyloides stercoralis. A physical exam revealed a poor general condition, anemia, dehydration and a distended painful abdomen with guarding, without abdominal sounds. The radiological study showed marked dilation of the small bowel that was edematous. Resection of the affected loop was performed and the histopathologic study showed transmural infection with S. stercoralis and hemorrhagic necrosis of the muscular layer, without mucosal destruction. The patient developed malabsorption syndrome and septic shock; he was treated with antibiotics and thiabendazole and was finally discharged in a good general condition. CVID is a rare disease and its association with systemic strongyloidiasis is very uncommon, but it has been reported in patients on corticosteroids. Hemorrhagic necrosis of the muscular layer without mucosal destruction was not found in the literature studied.

[Necrotic eosinophilic angiitis with ileal perforation and peritonitis secondary to abdominal angiostrongyliasis]. / Angéite nécrosante à éosinophiles avec perforation iléale et péritonite secondaire à une angiostrongylose abdominale.

INTRODUCTION: Abdominal angiostrongyliasis caused by the filiform nematode Angiostrongylus costaricensis, is an endemic disease in Central and South America. A case of necrotic eosinophilic angeitis with ileum perforation and peritonitis due to abdominal angiostrongyliasis is reported. OBSERVATION: A 32 year-old man, living in a Paris suburb, underwent segmentary resection of the ileum with end to end anastomosis for perforation with generalized peritonitis. The anatomopathological examination revealed eosinophilic necrotic lesions with thrombosis on the borders of the ileum perforation. The discovery of a section of A. costaricensis in the lumen of a nearby muscular artery initiated an epidemiological survey, revealing that the patient had visited French Guyana 2 months earlier. DISCUSSION: Angiostrongylus costaricensis is a nematode parisiting certain forest rodents that become its permanent host. The intermediate hosts are earth molluscs or slugs of the same family. Humans are accidentally infected following ingestion of vegetables infested with L3 larvae or slugs carrying the disease. The clinical symptomatology is unspecific: prolonged fever, anorexia, and right iliac fossa pain with eosinophilia of the blood. Often benign, the progression of abdominal angiostrongylosis is punctuated by complications: occlusive syndrome, generalised peritonitis due to intestinal perforation and mass syndrome. Hemorrhage, infarct, pseudo-tumoural fibrosis and ulcers represent the surgical or macroscopic rearrangements. In the tissue, 4 lesions characterize abdominal angiostrongylosis: eosinophilic necrotic angeitis, foreign body granulomas, eosinophilia in the digestive wall, and the presence of A. costaricensis in the lumen of the vessels. There is presently no medical treatment and surgery is the only therapeutic option.

Estrongiloidiasis: presentación quirurgica de dos casos en el Hospital Central SSPNP-1988 / Strongyloidiasis: surgical presentation of two cases

Se presenta una revisión de estrongiliodiasis con las manifestaciones clinicas de infeccion cronica, autoinfestación y sindrome de hiperinfeccion con sus letales complicaciones, asi como una revision del sindrome de seudo obtruccion intestinal cronica a proposito de dos casos de estrongiliodiasis que se presentaron con complicaciones quirúrgicas en el Departamento de Cirugia del Hospital Central SSPNP, en el año de 1988. Es importante recordar que si bien es una parasitosis no muy frecuente, puede presentarse con cuadros clinicos muy severos y con algunas complicaciones de solución quirúrgica(colecistitis aguda, perforacion intestinal con peritonitis, obtruccion intestinal, colitis ulcerativa severa, megacolon toxico y abceso pulmonar). Se reporta un caso cuyo comportamiento clínico y radiológico, asi como anatomopatológico es compatible con el síndrome de seudo obstrucción intestinal crónico, complicación no reportada en la bibliografía revisada lo que habla de su rareza