title: IBD or strongyloidiasis?
abstract: BACKGROUND
  Strongyloides has been shown to infrequently mimic inflammatory bowel disease (IBD) or to disseminate when a patient with IBD and unrecognized strongyloides is treated with immunosupression.
  
  
  METHODS
  A man from Ecuador, living in Spain for years, with a history of type 2 diabetes mellitus and psoriasis treated with topical corticosteroids, was admitted to the hospital with an 8-month history of diarrhoea. Blood tests showed hyperglycemia, hyponatremia, elevated CRP and faecal calprotectin. Colonoscopy suggested IBD. The patient improved with steroids, pending biopsy results, and he was discharged. Biopies were compatible with IBD, but careful examination revealed strongyloides. He was given a prescription of albendazole. He had to be readmitted due to SIADH, which resolved with fluid restriction. Upon discharge albendazole was prescribed again. The patient skipped most of the out-patient-clinic visits. He returned a year later on 10 mg/week methotrexate, asymptomatic, with 20% eosinophilia, and admitting he had never taken the strongyloides treatment for economical reasons. He then received a week of oral albendazol at the hospital. Biopsies and blood cell count were afterwards normal (eosinophils 3.1%) and serology for strongyloides antibodies was negative.
  
  
  CONCLUSIONS
  This case is of interest for four rarely concurring reasons. It´s a worm infection that mimics IBD; the infection was diagnosed by colon biopsy; the infection caused a SIADH; and, most interestingly, even though the patient is on immunosupression, he remains asymptomatic.
authors.affiliation: Gastroenterología y Hepatología, Hospital Clínico Universitario de Valencia, España.
authors.forename: Marta Maia
authors.initials: MM
authors.lastname: Boscá Watts
authors.affiliation: Medicina Digestiva, Hospital Clínico Universitario. Valencia, ESPAÑA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marco Marqués
authors.affiliation: Endocrinología, Hospital Clínico Universitario. Valencia, ESPAÑA.
authors.forename: Ester
authors.initials: E
authors.lastname: Savall-Núñez
authors.affiliation: Endocrinología, Hospital Clínico Universitario. Valencia, ESPAÑA.
authors.forename: Ana
authors.initials: A
authors.lastname: Artero-Fullana
authors.affiliation: Medicina Digestiva, Hospital Clínico Universitario. Valencia, ESPAÑA.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Lanza Reynolds
authors.affiliation: Anatomía Patológica, Hospital Clínico Universitario. Valencia, ESPAÑA.
authors.forename: Verónica
authors.initials: V
authors.lastname: Andrade Gamarra
authors.affiliation: Anatomía Patológica, Hospital Clínico Universitario. Valencia, ESPAÑA.
authors.forename: Víctor
authors.initials: V
authors.lastname: Puglia Santos
authors.affiliation: Anatomía Patológica, Hospital Clínico Universitario. Valencia, ESPAÑA.
authors.forename: Octavio
authors.initials: O
authors.lastname: Burgués Gasión
authors.affiliation: Medicina Digestiva, Hospital Clínico Universitario. Valencia, ESPAÑA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Mora Miguel
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000871:Anthelmintics / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007177:Inappropriate ADH Syndrome / Q000150:complications; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D008297:Male; D013322:Strongyloidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology
chemical_list: D000871:Anthelmintics; D007166:Immunosuppressive Agents; D015766:Albendazole