Publication

Abstract : A 55-year-old male, who was a known case of sarcoidosis and had been on steroids for the last 13 years, presented with weight loss over the previous 2–3 months, loss of appetite, intermittent loose stools, abdominal discomfort, and frequent flatulence. Colonoscopy showed aphthous ulcers (Fig. 1A) in the rectum and in the descending, transverse and ascending colon as well as in the splenic, and hepatic flexures (see Supplementary Material Video S1). Histopathological examination of a biopsy from the ulcerated mucosa showed a dense infiltrate of eosinophils in the lamina propria, associated with patchy ulceration, and Strongyloides stercoralis in the mucosal crypts (Fig. 1B). Stool examination showed plenty of rabditiform larvae of S. stercoralis (Fig. 1C). The patient was diagnosed with hyperinfection syndrome due to S. stercoralis. S. stercoralis is an intestinal pathogen seen both in immunocompetent individuals as well as in those with defects in cell-mediated immunity [[1]]. Three 2-day courses of ivermectin 200 μg/kg/day, every 15 days, resulted in a full symptomatic resolution.