Possible Strongyloides stercoralis infection diagnosed by videocapsule endoscopy in an immunocompetent patient with devastating diarrhea
A 70-year-old, housewife, living in a small village, presented with a six-month history of more than 10 watery diarrheas per day and loss of 18 kilos of body weight. Laboratory data were normal, including hemoglobin, white cell count and differential, CRP, serum albumin and immunoglobulin, iron, feritin, vitamin B12, and folate. Chest x-ray was normal. ESR was 40 mm/h. Stool examination for hemoglobin, leukocytes, parasites and cultures for pathogens was negative (twice). Colonoscopy with biopsies was normal. Duodenal biopsies showed mild, non-diagnostic changes of mucosa villi. Antibodies to tissue transglutaminase, endomysial antibodies and serum chromogranin-A were negative, including HIV infection. A small bowel videocapsule endoscopy (SBVCE) study showed mucosal areas of denuded villi and prominent small bowel submucosal vessels in the jejunum, multiple linear whitish lesions surrounded by reddish mucosa (), and parasites within the ileal fluid, entering the ileal mucosa (). These SBVCE findings favored the diagnosis of Strongyloides stercoralis infection. Review of previous histology of small bowel and colon, two more stool examinations for parasites and serum IgG antibodies against Strongyloides stercoralis (ELISA) were negative. She also tested negative for the HTLV-1 co-infection. The patient was treated with two cycles of albendazole 400 mg/d for 7 days. At 6-month follow up, she had no diarrhea and gained 4 kg of body weight.