Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3367-3375
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3367
Strongyloidiasis: A case with acute pancreatitis and a literature review
Jasbir Makker, Bhavna Balar, Masooma Niazi, Myrta Daniel
Jasbir Makker, Bhavna Balar, Myrta Daniel, Division of Gastroenterology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, New York, NY 10457, United States
Jasbir Makker, Bhavna Balar, Myrta Daniel, Department of Medicine, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, New York, NY 10457, United States
Masooma Niazi, Department of Pathology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, New York, NY 10457, United States
Author contributions: Makker J wrote the manuscript; Niazi M provided the pathology images; Balar B and Daniel M edited the final version of manuscript.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: Authors have no conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jasbir Makker, MD, Division of Gastroenterology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine of Yeshiva University, 1650 Grand Concourse, Bronx, New York, NY 10457, United States. makkerjs@gmail.com
Telephone: +1-347322-8242 Fax: +1-718518-5111
Received: October 13, 2014
Peer-review started: October 14, 2014
First decision: November 14, 2014
Revised: November 24, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: March 21, 2015
Processing time: 157 Days and 13.3 Hours
Abstract

Strongyloides stercoralis, a soil transmitted helminth infection, affects millions with varying prevalence worldwide. A large number of affected hosts are asymptomatic. Symptoms pertaining to pulmonary and gastrointestinal involvement may be present. Manifestations of involvement beyond lung and intestine can be seen with dissemination of infection and lethal hyperinfection. Immunosuppression secondary to use of steroids or other immunosuppressants and coexistence of human T-lymphotropic virus type-1 are the known risk factors for dissemination and hyperinfection. Diagnostic modalities comprise stool examination, serology and molecular testing. Stool tests are inexpensive but are limited by low sensitivity, whereas serologic and molecular tests are more precise but at the expense of higher cost. Treatment with Ivermectin or Albendazole as an alternative is safe and efficacious. We present a rare case of acute pancreatitis secondary to Strongyloides. High index of suspicion in patients specifically from endemic countries of origin and lack of other common etiologies of acute pancreatitis may help in early diagnosis and prompt treatment of this potentially fatal infection.

Keywords: Strongyloides; Pancreatitis; Autoinfection; Helminth; Eosinophilia

Core tip: Strongyloides affects millions of people worldwide. Large numbers of infected hosts are asymptomatic or have non-specific gastrointestinal and/or pulmonary symptoms. Infected hosts, especially in the setting of human T-lymphotropic virus type-1 infection and immunosuppressant or steroid use, may develop overwhelming infection in the form of dissemination or hyperinfection. Peripheral eosinophilia may be the only non-specific finding. Diagnostic methods range from simple stool examination to serologic tests and molecular techniques based on nucleic acid amplification. Endoscopic examination may be needed which may provide evidence of infection on pathological exam. Treatment options are both safe and efficacious with oral Ivermectin being superior to Albendazole.