RESUMO
A 40-year-old woman from El Salvador presented with 3 months of abdominal pain and diarrhea followed by 2 weeks of atypical chest pain and exertional dyspnea and was diagnosed with eosinophilic endocarditis secondary to Strongyloides stercoralis infection. Transthoracic echocardiogram revealed apical masses in the left and right ventricles and a thickened posterior mitral valve leaflet and cardiac magnetic resonance imaging confirmed the presence of a left ventricular apical mass with diffuse subendocardial delayed enhancement consistent with endocardial fibrosis. In conclusion, eosinophilic endocarditis is a rare cause of restrictive cardiomyopathy characterized by endomyocardial fibrosis and apical thrombosis and fibrosis with frequent involvement of the posterior mitral valve leaflet.
Assuntos
Síndrome Hipereosinofílica/diagnóstico , Strongyloides stercoralis , Estrongiloidíase/diagnóstico , Adulto , Animais , Cardiomiopatia Restritiva/diagnóstico , Cardiomiopatia Restritiva/patologia , Cardiomiopatia Restritiva/cirurgia , Ecocardiografia , El Salvador/etnologia , Emigrantes e Imigrantes , Endocárdio/patologia , Endocárdio/cirurgia , Fibrose Endomiocárdica/diagnóstico , Fibrose Endomiocárdica/patologia , Fibrose Endomiocárdica/cirurgia , Feminino , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , Humanos , Síndrome Hipereosinofílica/patologia , Síndrome Hipereosinofílica/cirurgia , Hipertrofia Ventricular Esquerda/diagnóstico , Imageamento por Ressonância Magnética , Miocárdio/patologia , Estrongiloidíase/patologia , Estrongiloidíase/cirurgia , Trombose/diagnóstico , Ultrassonografia Doppler , Estados UnidosRESUMO
A 29 year old female HIV-positive patient presented in emergency with acute right lower quadrant abdominal pain, fever, tenderness and positive Blumberg sign. Laboratorial tests revealed eosinophilia, anaemia and leukocytosis. She underwent exploratory laparotomy followed by appendectomy. The pathological analysis of the appendix revealed acute appendicitis, accentuated eosinophilia and infestation by Strongyloides stercoralis and Enterobius vermicularis. She did well after surgery and adequate treatment. To the authors' knowledge, this is the first case of eosinophilic acute appendicitis caused by these two parasitic worms reported in the medical literature.
Assuntos
Apendicite/parasitologia , Enterobíase/diagnóstico , Eosinofilia/parasitologia , Soropositividade para HIV , Estrongiloidíase/diagnóstico , Adulto , Animais , Apendicite/cirurgia , Diagnóstico Diferencial , Enterobíase/cirurgia , Enterobius , Feminino , Humanos , Strongyloides stercoralis , Estrongiloidíase/cirurgiaRESUMO
We report an immunodeficient patient with a rare gastrointestinal manifestation. A 26-year-old male with common variable immunodeficiency (CVID) and bronchiolitis obliterans, who was on intravenous gamma-globulin and prednisone, presented diffuse abdominal pain, nausea, vomiting and constipation of 3 days' duration. He reported 5 years of recurrent respiratory infections and diarrhea with negative stool tests, including tests for Strongyloides stercoralis. A physical exam revealed a poor general condition, anemia, dehydration and a distended painful abdomen with guarding, without abdominal sounds. The radiological study showed marked dilation of the small bowel that was edematous. Resection of the affected loop was performed and the histopathologic study showed transmural infection with S. stercoralis and hemorrhagic necrosis of the muscular layer, without mucosal destruction. The patient developed malabsorption syndrome and septic shock; he was treated with antibiotics and thiabendazole and was finally discharged in a good general condition. CVID is a rare disease and its association with systemic strongyloidiasis is very uncommon, but it has been reported in patients on corticosteroids. Hemorrhagic necrosis of the muscular layer without mucosal destruction was not found in the literature studied.
Assuntos
Imunodeficiência de Variável Comum/complicações , Gastroenteropatias/complicações , Strongyloides stercoralis/crescimento & desenvolvimento , Estrongiloidíase/complicações , Corticosteroides/efeitos adversos , Adulto , Animais , Imunodeficiência de Variável Comum/imunologia , Gastroenteropatias/imunologia , Gastroenteropatias/parasitologia , Gastroenteropatias/cirurgia , Histocitoquímica , Humanos , Masculino , Strongyloides stercoralis/imunologia , Estrongiloidíase/imunologia , Estrongiloidíase/parasitologia , Estrongiloidíase/cirurgiaAssuntos
Doenças do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Strongyloides stercoralis , Estrongiloidíase/diagnóstico por imagem , Animais , Diagnóstico Diferencial , Humanos , Mucosa Intestinal/parasitologia , Mucosa Intestinal/patologia , Doenças do Jejuno/patologia , Doenças do Jejuno/cirurgia , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Jejuno/diagnóstico por imagem , Jejuno/patologia , Jejuno/cirurgia , Larva , Masculino , Pessoa de Meia-Idade , Radiografia , Strongyloides stercoralis/ultraestrutura , Estrongiloidíase/patologia , Estrongiloidíase/cirurgiaRESUMO
Se presenta una revisión de estrongiliodiasis con las manifestaciones clinicas de infeccion cronica, autoinfestación y sindrome de hiperinfeccion con sus letales complicaciones, asi como una revision del sindrome de seudo obtruccion intestinal cronica a proposito de dos casos de estrongiliodiasis que se presentaron con complicaciones quirúrgicas en el Departamento de Cirugia del Hospital Central SSPNP, en el año de 1988. Es importante recordar que si bien es una parasitosis no muy frecuente, puede presentarse con cuadros clinicos muy severos y con algunas complicaciones de solución quirúrgica(colecistitis aguda, perforacion intestinal con peritonitis, obtruccion intestinal, colitis ulcerativa severa, megacolon toxico y abceso pulmonar). Se reporta un caso cuyo comportamiento clínico y radiológico, asi como anatomopatológico es compatible con el síndrome de seudo obstrucción intestinal crónico, complicación no reportada en la bibliografía revisada lo que habla de su rareza