Universidad Peruana Cayetano Heredia

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

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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.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
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


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