An Unusual Case of Lethal Strongyloides stercoralis-Associated Chronic Fulminant Colitis in an Immunocompetent Patient.

IF 1 Q4 INFECTIOUS DISEASES Case Reports in Infectious Diseases Pub Date : 2024-06-27 eCollection Date: 2024-01-01 DOI:10.1155/2024/4223529
Joseph Do Woong Choi, Rukmini Kulkarni, Aswin Shanmugalingam, Charlotte Kwik, Indy Sandaradura, Jasveen Renthawa, Matthew R Watts, James Wei Tatt Toh
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Abstract

A 70-year-old immunocompetent Lebanese male presented with 3-month history of watery diarrhoea and abdominal pain after recently arriving to Australia from Lebanon. He had a colectomy for an iatrogenic bowel perforation associated with a colonoscopy in Lebanon several months prior. His computed tomography (CT) scan demonstrated pancolitis. Stool culture and polymerase chain reaction (PCR) were positive for Strongyloides stercoralis. Despite Strongyloides treatment and total parenteral nutrition, his pancolitis unexpectedly persisted despite negative stool cultures, and the patient failed to progress over several weeks with worsening abdominal pain. A colectomy was considered. However, due to his recent myocardial infarct requiring cardiac stenting, his anticoagulant and antiplatelets could not be ceased for at least 3 months without significant cardiac risk. After hospitalisation for several weeks in Australia, he was discharged against medical advice and flew back to Lebanon, where he presented with worsening pain and underwent a subtotal colectomy. Unfortunately, he developed multiorgan failure and died 3 weeks following his colectomy. Strongyloides-related pancolitis is a rare condition in immunocompetent adults that has the potential to persist and be lethal, despite microbiological antiparasitic eradication.

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一例免疫功能正常患者感染致命性盘尾丝虫相关慢性暴发性结肠炎的罕见病例
一名 70 岁免疫功能正常的黎巴嫩男性患者最近从黎巴嫩来到澳大利亚,3 个月前出现水样腹泻和腹痛。几个月前,他在黎巴嫩因结肠镜检查引起的先天性肠穿孔而接受了结肠切除术。计算机断层扫描(CT)显示他患有胰腺炎。粪便培养和聚合酶链反应(PCR)结果显示,盘尾丝菌呈阳性。尽管接受了斯特龙线虫治疗和全肠外营养,但尽管粪便培养呈阴性,胰腺炎还是意外地持续存在,而且患者的病情在数周内没有进展,腹痛加剧。考虑进行结肠切除术。然而,由于他最近发生了心肌梗塞,需要做心脏支架手术,因此在没有重大心脏风险的情况下,至少 3 个月内不能停用抗凝剂和抗血小板药物。在澳大利亚住院数周后,他违背医嘱出院并飞回黎巴嫩,在那里他因疼痛加剧而接受了结肠次全切除术。不幸的是,他出现了多器官衰竭,并在结肠切除术后 3 周死亡。在免疫功能正常的成年人中,与盘尾丝虫相关的胰腺炎是一种罕见的疾病,尽管已经根除了微生物抗寄生虫,但这种疾病仍有可能持续存在并导致死亡。
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审稿时长
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