dc.date.accessioned2019-02-06T14:57:38Z
dc.date.available2019-02-06T14:57:38Z
dc.date.created2019-02-06T14:57:38Z
dc.date.issued2015
dc.identifierhttps://hdl.handle.net/20.500.12866/5473
dc.identifierhttps://doi.org/10.4269/ajtmh.15-0355
dc.description.abstractA 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.languageeng
dc.publisherAmerican Society of Tropical Medicine and Hygiene
dc.relationAmerican Journal of Tropical Medicine and Hygiene (ASTMH Journal)
dc.relation1476-1645
dc.rightshttps://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectAnimals
dc.subjectAnthelmintics/therapeutic use
dc.subjectAcute Disease
dc.subjectStrongyloides stercoralis
dc.subjectGastrointestinal Hemorrhage/etiology/parasitology
dc.subjectImmunocompromised Host/immunology
dc.subjectIvermectin/therapeutic use
dc.subjectPituitary ACTH Hypersecretion/complications/diagnosis/immunology/parasitology/pathology
dc.subjectPituitary Gland, Anterior/pathology
dc.subjectStrongyloidiasis/complications/diagnosis
dc.titleStrongyloides stercoralis hyperinfection syndrome presenting as severe, recurrent gastrointestinal bleeding, leading to a diagnosis of cushing disease
dc.typeinfo:eu-repo/semantics/article


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