dc.date.accessioned | 2019-02-06T14:57:38Z | |
dc.date.available | 2019-02-06T14:57:38Z | |
dc.date.created | 2019-02-06T14:57:38Z | |
dc.date.issued | 2015 | |
dc.identifier | https://hdl.handle.net/20.500.12866/5473 | |
dc.identifier | https://doi.org/10.4269/ajtmh.15-0355 | |
dc.description.abstract | 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. | |
dc.language | eng | |
dc.publisher | American Society of Tropical Medicine and Hygiene | |
dc.relation | American Journal of Tropical Medicine and Hygiene (ASTMH Journal) | |
dc.relation | 1476-1645 | |
dc.rights | https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es | |
dc.rights | info:eu-repo/semantics/restrictedAccess | |
dc.subject | Humans | |
dc.subject | Male | |
dc.subject | Middle Aged | |
dc.subject | Animals | |
dc.subject | Anthelmintics/therapeutic use | |
dc.subject | Acute Disease | |
dc.subject | Strongyloides stercoralis | |
dc.subject | Gastrointestinal Hemorrhage/etiology/parasitology | |
dc.subject | Immunocompromised Host/immunology | |
dc.subject | Ivermectin/therapeutic use | |
dc.subject | Pituitary ACTH Hypersecretion/complications/diagnosis/immunology/parasitology/pathology | |
dc.subject | Pituitary Gland, Anterior/pathology | |
dc.subject | Strongyloidiasis/complications/diagnosis | |
dc.title | Strongyloides stercoralis hyperinfection syndrome presenting as severe, recurrent gastrointestinal bleeding, leading to a diagnosis of cushing disease | |
dc.type | info:eu-repo/semantics/article | |