Eosinophilic Ascites Due to Hyperinfection with Strongyloides stercoralis

We report the case of a patient with cryptogenic cirrhosis, new onset ascites, and hyperinfection with Strongyloides stercoralis who had significant eosinophilia of the peritoneal fluid. The eosinophilia resolved with treatment of the S. stercoralis infection, and did not recur during two subsequent episodes of ascites and spontaneous bacterial peritonitis. Eosinophilic ascites is rare in parasitic infection, but it has been described in a variety of disorders which are discussed.     

内镜下微波治疗非门脉高压上消化道出血

目的 :探讨内镜下微波治疗非门脉高压上消化道出血的疗效。方法 :将 6 2例有活动性出血的非门脉高压上消化道出血病例分 2组 ,比较内镜下微波治疗与过去传统治疗的效果。结果 :止血效果内镜下微波治疗优于传统治疗 ,近期再出血率、近期急诊手术率、平均住院时间及病死率均有显著性差异 (P <0 .0 5 )。本组治疗未见并发症。结论 :内镜下微波治疗非门脉高压上消化道出血疗效肯定 ,方法简便 ,经济 ,使用安全     

Massive Upper Gastrointestinal Hemorrhage from a Granular Cell Tumor of the Stomach

The first case of massive upper gastrointestinal hemorrhaging from a granular cell tumor of the stomach is reported. The clinical and pathologic characteristics of the 15 previously reported cases are reviewed and the theories of the histogenesis of this lesion are briefly discussed.     

Azotemia in Upper Gastrointestinal Hemorrhage

The cause of the azotemia associated with gastrointestinal hemorrhage has been controversial but review of the literature reveals consistent findings. If extraneous, complicating factors are excluded, the azotemia produced with blood ingestion does not reproduce that seen with gastrointestinal hemorrhage. Azotemia with blood ingestion alone demonstrates a mild peak and usually lasts less than 24 hours, whereas that seen clinically is both higher and longer and a manifestation of blood ingestion plus the renal effects of hypovolemia. The hypovolemia contributes quantitatively more than the digestion of blood and is the sole determinant of azotemia after 24 hours. Consequently, azotemia which persists beyond this time indicates either continuation of bleeding, continuation of hypovolemia insult or intrinsic renal disease. Persistent azotemia following gastrointestinal hemorrhage is an indication for re-evaluation of fluid management.     

Case Report: Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe,Recurrent Gastrointestinal Bleeding,Leading to a Diagnosis of Cushing Disease

A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia/melena requiring > 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 am cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of Strongyloides stercoralis, indicating Strongyloides hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection.     

Eosinophilic ascites due to Strongyloides stercoralis.

We report the case of a patient with eosinophilic ascites in whom filariform larvae of Strongyloides stercoralis were found in smears of the ascitic fluid. The ascites resolved after therapy with albendazole. Eosinophilic ascites can rarely result from parasitic infections including Strongyloides stercoralis.     

Chronic relapsing colitis due to Strongyloides stercoralis

The small intestine is the usual site of chronic infection with Strongyloides stercoralis. Colonic involvement has generally been seen in the hyperinfection syndrome in immunosuppressed individuals. We describe an immunologically competent female who underwent multiple abdominal operations over a 5-year period for hematochezia and diffuse abdominal pain of obscure etiology. Eosinophilia had been present but never investigated until 1981, at which time stool examination revealed S. stercoralis larvae. Pathological specimens from operations in 1977 and 1981 demonstrated extensive colonic wall invasion with filariform larvae consistent with S. stercoralis. Involvement of other organs was never documented. We believe this case is consistent with chronic colitis due to strongyloidiasis. This entity has not been previously described, and expands the spectrum of this disease.