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CC BY-NC-ND 4.0 · Journal of Gastrointestinal Infections
DOI: 10.1055/s-0044-1787857
Case Report

Gastrointestinal Bleeding as a Clinical Manifestation of Strongyloides stercoralis Hyperinfection in a Patient with HIV: A Case Report

Pedro Felipe Miranda Badaró
1   Department of Life Sciences, University of State of Bahia, Salvador, Brazil
,
Cláudia de Abreu Cardoso Machado
2   Gastroenterology Division, Hospital da Bahia, Dasa, Salvador, Brazil
,
Luiz Antônio Rodrigues de Freitas
3   Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
4   IMAGEPAT, Salvador, Brazil
,
Renata Dias Araujo Branco
5   Radiology Center, Hospital da Bahia, Dasa, Salvador, Brazil
,
Bruno César da Silva 
2   Gastroenterology Division, Hospital da Bahia, Dasa, Salvador, Brazil
› Author Affiliations Funding None.
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Abstract

Strongyloidiasis, caused by the nematode Strongyloides stercoralis, is an often neglected parasitic disease, with deeper prevalence in tropical and subtropical regions. This parasitic infection can range from asymptomatic to symptomatic, with nonspecific manifestations, including gastrointestinal symptoms. Herein, we reported the case of an human immunodeficiency virus (HIV)-positive patient, under effective antiretroviral treatment with a normal CD4 count, who was hospitalized due to gastrointestinal bleeding. The diagnosis of strongyloidiasis hyperinfection was confirmed following endoscopic biopsies of both the gastric and duodenal mucosa. Subsequently, a treatment regimen of ivermectin at a dosage of 200 mcg/kg/day for a duration of 14 days was initiated, leading to notable amelioration in the patient's clinical presentation. In considering the differential diagnosis of gastrointestinal bleeding, it is crucial to explore various possibilities, including peptic ulcers, portal hypertension, and cancer. Among immunocompromised individuals like those with HIV, chronic infection can compromise the Th2 immune response, which is pivotal in combating helminthic infections. This underscores the importance of remembering intestinal parasitosis, particularly strongyloidiasis, in such cases. Even in patients with preserved CD4 counts, careful evaluation for opportunistic infections in HIV-positive individuals is paramount. Early initiation of treatment is essential to mitigate the risk of serious complications.

Keywords

gastrointestinal bleeding - HIV - strongyloidiasis

Ethical Statement

The patient signed an informed consent form, authorizing the publication of this case.


Authors' Contributions

Conception and design of the study: B.C.S, P.F.M.B. Generation, collection, assembly, analysis, and/or interpretation of data: B.C.S., C.A.C.M., L.A.R.F., R.D.A.B. Drafting or revision of the manuscript: B.C.S, P.F.M.B., C.A.C.M. Approval of the final version of the manuscript: All the authors approved the final manuscript. Guarantor of article: B.C.S.


Informed Consent

The case report was consented by the patient.


Data Availability Statement

There is no data associated with this work.




Publication History

Received: 11 April 2024

Accepted: 19 May 2024

Article published online:
05 August 2024

© 2024. Gastroinstestinal Infection Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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