Strongyloides Stercoralis Hyperinfection  Presenting as Subacute Intestinal  Obstruction

Vinay Khanna; Anusha G; Manjunatha Hande H; Shashidhar V; Chiranjay Mukhopadhyay

Volume : II, Issue : IX, September - 2013

Strongyloides Stercoralis Hyperinfection Presenting as Subacute Intestinal Obstruction

Vinay Khanna, Anusha G, Manjunatha Hande H, Shashidhar V, Chiranjay Mukhopadhyay

Abstract :

A 25 year old male with no premorbid illness presented with abdominal pain for 9 days and associated vomiting and constipation for the past 2 days. The abdominal pain increased after food intake and was associated with nausea and vomiting. He also experienced loss of appetite and loss of weight for the last 2 months. He had no past history of tuberculosis. On examination, the patient had pallor and a palpable mass in the right lumbar region. X ray Abdomen showed multiple air fluid levels and hence patient was initially suspected to have subacute intestinal obstruction. Laboratory analysis revealed normocytic normochromic anaemia with eosinophilia, high platelet counts, normal serum total protein levels, reversed albumin globulin ratio and normal serum liver and pancreatic function tests. Parasitology examination of the stool showed numerous larva of Strongyloides stercoralis. Agar stool culture was done and tracks of migrating Strongyloides stercoralis larva were seen. Patient was diagnosed to have Strongyloides stercoralis hyperinfection syndrome and was treated with T. Ivermectin. Patient showed symptomatic improvement in two days of starting therapy. He was evaluated for Human immunodeficiency virus (HIV) and was found to be HIV positive with a CD4 count of 155. As patient requested discharge from the hospital due to financial constraints, a repeat stool examination could not be done to prove eradication of the larva from the intestine.