Korean J Gastroenterol.  2023 Jun;81(6):270-275. 10.4166/kjg.2023.036.

Rare Complication of Strongyloidiasis in Vietnam: A Case of Venous Thromboembolism and Duodenal Obstruction

• Manh TH
• Tran KQL
• Ho PT
• Vo MM
• Pham TQ
• Vo TD

• KMID: 2543448
• DOI: http://doi.org/10.4166/kjg.2023.036

Abstract

Strongyloidiasis, a chronic helminth infection caused by the parasitic nematode Strongyloides stercoralis, has various clinical manifestations. Although rare, duodenal obstructions and venous thromboembolism are possible complications of strongyloidiasis. This paper presents the case of a 47-year-old Vietnamese male with a history of right lower limb edema, anorexia, nausea, vomiting, diarrhea, and abdominal discomfort lasting for four months. Venous Doppler ultrasound detected a thrombus in the right femoral vein, while an abdominal CT scan revealed a mass lesion suggestive of a lower bile duct tumor. Esophageogastroduodenoscopy showed a friable duodenal cap mucosa with multiple ulcers and edematous mucosa of the second part of the duodenum that caused a partial lumen obstruction. The final histological examination of the biopsy specimen revealed chronic duodenitis with larvae consistent with Strongyloides stercoralis. The patient was treated with Ivermectin for two weeks and anticoagulation therapy for three months. After treatment and a six-month follow-up, the patient's gastrointestinal symptoms and leg swelling resolved completely. This is the first documented case of a patient in Vietnam with strongyloidiasis who presented with venous thromboembolism and duodenal obstruction. (Korean J Gastroenterol 2023;81:270-275)

Keyword

Strongyloidiasis; Venous thromboembolism; Duodenal obstruction; Vietnam

Figure

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  Fig. 1 CT findings. Abdominal CT, coronal plane (A), and transversal plane (B) showed the showing a soft tissue density filling defect in the distal common bile duct representing cancerous mass (the yellow arrows).

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  Fig. 2 Images from EGD. Ulceration and erosions (the white arrow) at the duodenal cap (A). Edema cause semi-obstruction (the white arrow) at the superior duodenal flexure and the second part of the duodenum (B). EGD, esophagogastroduodenoscopy.

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  Fig. 3 Histological aspects of strongyloidiasis in the duodenum. The section of parasite larvae in the duodenum biopsy was observed (H&E, ×400). H&E stained sections of the duodenal biopsy. (A) The image shows numerous Strongyloides stercoralis larvae (green arrows) in the tissue. There is marked eosinophilic infiltration. (H&E, ×100). (B) The image shows larvae and lots of S. stercoralis eggs (blue arrow) inside the nematode in the tissue (H&E, ×400). (C) The image shows S. stercoralis larvae in the tissue (H&E, ×400).

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