Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding

Figure 1 Endoscopic findings. A: Extensive confluent necrotic ulcerations of the duodenal mucosa due to chemotherapy related S. stercoralis helminthic hyper-infection. B: Enteroscopic presentation of diffuse mucosal bleeding during anthelminthic therapy of S. stercoralis hyper-infection, aggravated potentially by toxic/inflammatory compounds from destroyed parasites.

Figure 2 S. stercoralis larvae in the stool.

Figure 3 A: Intraluminal and intramucosal S. stercoralis larvae in the duodenum during the exudative enteropathy hyper-infection phase (arrows). Scale: 200 μm. B: No intramural or peri-vascular inflammatory cell clusters are recognised during this early period of infection. Scale: 50 μm.

Figure 4 A: Segmental vasospasms (circled area). B: “berry-type” micro-aneurysms (circled area) in the mesenteric superior and inferior arteries’ territory are both suggestive of active vasculitis during the anthelminthic therapy of S. stercoralis hyper-infection.

Figure 5 Perivascular granulocytic infiltration in the mucosa during the anthelminthic therapy of S. stercoralis hyper-infection is also suggestive of active vasculitis. Scale: A: 200 μm; B: 50 μm.