Strongyloides stercoralis hyperinfection syndrome presenting as severe, recurrent gastrointestinal bleeding, leading to a diagnosis of cushing disease

U, Hoi-Sang; Vinetz, Joseph Michael; Chi, Nai-Wen; Savides, Thomas J.; Yee, Brittany; Lee, Roland R.; Hansen, Lawrence A.

dc.contributor.author	Yee, Brittany
dc.contributor.author	Chi, Nai-Wen
dc.contributor.author	Hansen, Lawrence A.
dc.contributor.author	Lee, Roland R.
dc.contributor.author	U, Hoi-Sang
dc.contributor.author	Savides, Thomas J.
dc.contributor.author	Vinetz, Joseph Michael
dc.date.accessioned	2019-02-06T14:57:38Z
dc.date.available	2019-02-06T14:57:38Z
dc.date.issued	2015
dc.identifier.uri	https://hdl.handle.net/20.500.12866/5473
dc.description.abstract	A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia/melena requiring > 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 am cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of Strongyloides stercoralis, indicating Strongyloides hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection.	en_US
dc.language.iso	eng
dc.publisher	American Society of Tropical Medicine and Hygiene
dc.relation.ispartofseries	American Journal of Tropical Medicine and Hygiene (ASTMH Journal)
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	Humans	en_US
dc.subject	Male	en_US
dc.subject	Middle Aged	en_US
dc.subject	Animals	en_US
dc.subject	Anthelmintics/therapeutic use	en_US
dc.subject	Acute Disease	en_US
dc.subject	Strongyloides stercoralis	en_US
dc.subject	Gastrointestinal Hemorrhage/etiology/parasitology	en_US
dc.subject	Immunocompromised Host/immunology	en_US
dc.subject	Ivermectin/therapeutic use	en_US
dc.subject	Pituitary ACTH Hypersecretion/complications/diagnosis/immunology/parasitology/pathology	en_US
dc.subject	Pituitary Gland, Anterior/pathology	en_US
dc.subject	Strongyloidiasis/complications/diagnosis	en_US
dc.title	Strongyloides stercoralis hyperinfection syndrome presenting as severe, recurrent gastrointestinal bleeding, leading to a diagnosis of cushing disease	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.4269/ajtmh.15-0355
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.03.06
dc.relation.issn	1476-1645