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A case of fatal malabsorption syndrome caused by strongyloidiasis complicated with isosporiasis and human cytomegalovirus infection
D H Yoon,1S J Yang,1J S Kim,1S T Hong,2J Y Chai,2S H Lee,2 and J G Chi3
1Taebaeg Jangseong General Hospital, Taebaeg, Kangwon-do, Korea.
2Department of Parasitology, Seoul National University College of Medicine, Seoul 110-460, Korea.
3Department of Pathology, Seoul National University College of Medicine, Seoul 110-460, Korea.
Abstract
This 54-year-old Korean coal miner suffered from continuous watery diarrhea and weight loss after corticosteroid treatment (β-methasone, 4 mg daily for 1 week) due to hip-bone fracture in January 1991. Except for the short therapy of steroid, no other histories were contributory. The malabsorption syndrome was aggravated while the case was treated under the impression of amebiasis or intestinal tuberculosis. AIDS antibody test by EIA was negative and quantitative analysis of serum immunoglobulins was in normal ranges. Nine months after the onset of symptoms, the case was diagnosed as malabsorption syndrome caused by complexed and aggravated infection by Strongyloides stercoralis, Isospora and cytomegalovirus in the small intestine, which were proved by stool examination and duodenal biopsy. His clinical course became worse even after high-dosed and prolonged albendazole treatment for strongyloidiasis with supportive fluid therapy. The patient was discharged in hopeless status in November, 1991 and died after one week at home.
Figures
Figs. 1-5 Fig. 1. External appearance of the patient with marked emaciation and severe weight loss due to malabsorption syndrome.
Fig. 2. The rhabditoid larva of Strongyloides stercoralis found from watery feces of the patient. EB: Esophageal bulb, GP: Genital primordium.
Fig. 3. An Isospora oocyst in the watery stool contains 2 sporocysts.
Fig. 4. Photomicrograph of the duodenal biopsy exhibiting sectioned invading larvae of S. stercoralis in the foveolar lumen. H & E, ×400.
Fig. 5. Tissue section of the duodenal biopsy shows intranuclear viral inclusion bodies (arrows) in the covering epithelia. H & E, ×400.
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