58 yo female
complaining of joint pains, inflammatory, with mouth and cutaneous lesions
in favor of Behcet disease. Recently, she has stomach pain, and weight
loss. Gastro-duodenal endoscopy is performed.
58 ans se plaignant d'arthralgies d'allure inflammatoire, avec aphtose
buccale plaques rythmato-purpuriques, en faveur d'une Maladie de Behcet.
Devant une altration de l'tat gnral avec amaigrissement rcents, et
pigastralgie, une gastro-duodnoscopie est ralise.
villous architecture is absent on the duodenal biopsy at low power. At
close up, rounded and elongated bodies are noted in the crypts.
on these structures.
These bodies are parasites,
rounded worms, elongated, showing on sections their digestive apparatus.
Strongyloides stercoralis is known to be a common source of infection
in Third World countries, is now recognized to be common in certain parts
of the United States, and may be endemic in institutions.The infection
may remain dormant and subclinical for many years. It is especially important
to diagnose and treat this infection prior to institution of immunosuppressive
therapy. Otherwise, an overwhelming fatal infection may follow. Gastrointestinal
symptoms, if present, are usually mild, with only minimal change in villous
architecture. Occasionally, heavy infestations may be T-associate with
a severe lesion of villous architecture and related severe malabsorption.
The primary mode of diagnosis is stool examination, although serologic
testing is an adjunct. Sometimes the diagnosis is made on the basis of
small bowel biopsy or biopsy from other parts of the gastrointestinal
tract. The possibility of endemic strongyloidiasis should always be considered
in patients who have unexplained high eosinophilic count.