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논문분류	춘계학술대회 초록집
제목	Beyond Routine: Disseminated Strongyloidiasis After Renal Transplant
저자	Yeoh Hung Yew
출판정보	2024; 2024(1):
키워드
초록	Introduction: Strongyloidiasis infection remained one of the most neglected tropical disease, affecting over 600 million people globally (1,2). Malaysia's pooled prevalence was 11.7% (3). We report a case of disseminated strongyloidiasis with gastric outlet obstruction. Case Description: A 43-year-old Indian man who received a deceased-donor kidney transplant, presented with 2 weeks of epigastric pain, projectile vomiting and diarrhoea. Examination was unremarkable. His immunosuppression included prednisolone, tacrolimus and everolimus. Laboratory testing showed white cell count of 16.6x10^9/L with high eosinophil count of 6.02x 10^9/L. Blood and urine cultures were negative. Strongyloides stercoralis larvae with ova cysts were found in the stool. Gastroenteroscopy revealed severely inflamed and edematous gastric mucosa with deformed pylorus causing gastric outlet obstruction. Antrum biopsy showed presence of Strongyloides stercoralis larvae and ova cysts He was treated with 2 weeks of oral Ivermectin 12mg daily and Albendazole 400mg twice daily. Repeated gastroenteroscopy showed healed antrum mucosa with normal histopathology. His symptoms resolved and was able to feed orally. Stool sample also showed clearance of larvae and ova cysts. Discussion The rarity of Strongyloides infection required high index of suspicion to make an early diagnosis. Retrospective review of patient’s pre-transplant evaluation revealed elevated eosinophil counts. Treatment with a single dose of Albendazole prior to transplant did not prevent infection in an immunocompromised person. Frequently, there may also be co-infection with other bacteria or viruses due to the generally immunosuppressed state of patients. As in this case, the man also had Salmonella non-typhi species and Cytomegalovirus (CMV) infection, which confounded diagnosis. Gastric outlet obstruction resulted in malabsorption and severe malnutrition. Nasojejunal tube proved useful in feeding and anti-helminth delivery.
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