Strongyloidiasis in a diabetic patient accompanied by gastrointestinal stromal tumor: cause of eosinophilia unresponsive to steroid therapy.
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.
Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju 501-757, Korea.
Eun Jeong
EJ
Won
Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Medical School, Gwangju 501-757, Korea.
Jin
J
Jeon
Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Medical School, Gwangju 501-757, Korea.
Young-Il
YI
Koh
Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju 501-757, Korea.
Dong Wook
DW
Ryang
D000368:Aged; D015766:Albendazole / Q000008:administration & dosage; D000818:Animals; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004802:Eosinophilia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000068877:Imatinib Mesylate / Q000008:administration & dosage*; D013256:Steroids / Q000008:administration & dosage*; D017171:Strongyloides stercoralis / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D013322:Strongyloidiasis / Q000188:drug therapy* / Q000469:parasitology
D013256:Steroids; D000068877:Imatinib Mesylate; D015766:Albendazole
PCR; Strongyloides stercoralis; gastrointestinal stromal tumor (GIST); hypereosinophilic syndrome; imatinib