Courtesy of Dr Gustavo Nava (Venezuela)
Given the following colon biopsy:


1. What is your diagnosis?
Strongyloidiasis (infection with the small nematode or roundworm, Strongyloides stercoralis). The organisms seen in the image are rhabditiform larvae. In this case there is lack of inflammation but some cases may show marked inflammation, villous blunting, edema or mucosal ulceration. The differential diagnosis includes infection by Capillaria philippinensis, but the latter is larger than Strongyloides spp. and usually restricted to the Phillipines.
2. What clinical symptoms do you expect this patient to have? Gastrointestinal symptoms, including diarrhea with or without malabsorption, abdominal pain, nausea, vomiting and weight loss. However, some patients may be asymptomatic. Pulmonary or skin symptoms are not discussed here.
3. Does this condition need to be treated? If so, what would be the recommended therapy?
Yes, thiabendazol is the recommended treatment. Ivermectin may be attempted in some cases. It is important to remember that patients receiving steroids are susceptible for Strongyloidiasis autoinfection and superinfection (high mortality). Steroid tapering in these patients is mandatory and avoiding steroids is also important once a diagnosis of Strongyloidiasis is established.
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