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- W2920795588 abstract "Infection with Strongyloides is a rarely reported infection in industrialized nations; usually only found in immunocompromised patients. We present a case of a 36 year-old Hispanic male with new onset cirrhosis found to have a Strongyloides infection. He presented with jaundice, abdominal swelling and lower extremity edema. He had moved to Shreveport, LA from Mexico 3 years prior to admission. Patient had no prior medical history. He took no medications, but did drink six beers daily. Patient was found to have a hemoglobin of 4.0 g/dL, WBC of 20,410/uL with eosinophilia, Total Bilirubin 3.3 mg/dL (direct bilirubin 2.1 mg/dL), AST/ALT 66/40 U/L, ALP 402, Iron/TIBC/T-sat 12/243/5%, urine drug screen was cocaine positive, Hepatitis panel, HIV, RPR were negative. Interestingly, ANA and anti-RNP antibodies were positive. IgG was elevated at 1,950 mg/dL. Anti-smooth muscle antibody was elevated at 26 units and anti-mitochondrial antibody was equivocal at 20.4 units. US of the abdomen showed cirrhotic changes of the liver and ascites without biliary dilation. Paracentesis was negative for infection and SAAG >1.1. EGD was performed and showed esophageal and gastric varies. Patient was transfused with packed red blood cells and started on spironolactone, furosemide and propranolol. He clinically improved and was discharged with close follow up for EGD and colonoscopy. After patient was discharged, the result of the serum Strongyloides IgG antibody test returned positive. Strongyloidiasis is more common in tropical regions, but it has an estimated prevalence of up to 1.2-4.9% in the US. Symptoms can range from asymptomatic with mild eosinophilia to disseminated disease in an immunosuppressed host. Most commonly infected individuals live in endemic rural areas and are asymptomatic. Diagnosis can be made either by detecting rhabditiform larvae in the stool or by serologic as in our patient. Treatment includes 2 day course of ivermectin or up to 7 days for disseminated disease. Our patient appears to have an underlying autoimmune disease process, which is unclear. His elevated ALP and elevations in Anti-smooth muscle antibody and Anti-mitochondrial antibody raise concern for autoimmune hepatitis. In literature, AIH shows an inverse relationship with development of Strongyloides infection. However, our patient also consumed alcohol which does correlate with increased incidence of Strongyloides infection." @default.
- W2920795588 created "2019-03-22" @default.
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- W2920795588 date "2018-10-01" @default.
- W2920795588 modified "2023-09-27" @default.
- W2920795588 title "Strongyloides Infection in Immunocompetent Patient With New Onset Cirrhosis" @default.
- W2920795588 doi "https://doi.org/10.14309/00000434-201810001-02423" @default.
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