Korean J Parasitol.  2015 Apr;53(2):223-226. 10.3347/kjp.2015.53.2.223.

Strongyloidiasis in a Diabetic Patient Accompanied by Gastrointestinal Stromal Tumor: Cause of Eosinophilia Unresponsive to Steroid Therapy

• Won EJ
• Jeon J
• Koh YI
• Ryang DW

• KMID: 2381821
• DOI: http://doi.org/10.3347/kjp.2015.53.2.223

Abstract

We report here a case of strongyloidiasis in a 72-year-old diabetic patient (woman) accompanied by gastrointestinal stromal tumor receiving imatinib therapy, first diagnosed as hypereosinophilic syndrome and treated with steroids for uncontrolled eosinophilia. She suffered from lower back pain and intermittent abdominal discomfort with nausea and diagnosed with gastrointestinal stromal tumor. After post-operative imatinib treatment eosinophilia persisted, so that steroid therapy was started under an impression of hypereosinophilic syndrome. In spite of 6 months steroid therapy, eosinophilia persisted. Stool examination was performed to rule out intestinal helminth infections. Rhabditoid larvae of Strongyloides stercoralis were detected and the patient was diagnosed as strongyloidiasis. This diagnosis was confirmed again by PCR. The patient was treated with albendazole for 14 days and her abdominal pain and diarrhea improved. This case highlights the need for thorough investigation, including molecular approaches, to test for strongyloidiasis before and during steroid therapies.

Keyword

Strongyloides stercoralis; imatinib; gastrointestinal stromal tumor (GIST); PCR; hypereosinophilic syndrome

MeSH Terms

Aged
Albendazole/administration & dosage
Animals
Diabetes Mellitus, Type 2/complications
Eosinophilia/complications/*drug therapy
Female
Gastrointestinal Stromal Tumors/complications/*drug therapy
Humans
Imatinib Mesylate/*administration & dosage
Steroids/*administration & dosage
Strongyloides stercoralis/genetics/isolation & purification/physiology
Strongyloidiasis/*drug therapy/parasitology
Albendazole
Imatinib Mesylate
Steroids