Strongyloidiasis: The Cause of Multiple Gastrointestinal Ulcers in an Immunocompetent Individual

Strongyloidiasis is a common parasitic disease in tropical regions of the world. Infection with Strongyloides stercoralis usually remains asymptomatic with peripheral eosinophilia and uncontrolled growth. Consequently, immunocompromised individuals are at a higher risk of complications of this disease. We present a case of an immunocompetent patient whose complaint of acute abdominal pain was found to be due to gastric and duodenal ulcerations. Laboratory examination revealed significantly elevated absolute eosinophil count at 11,466/mm3 (normal 0–700/mm3). The duodenal biopsy revealed parasitic ova and adult worms suggestive of Strongyloides stercoralis nematode with increased eosinophils in the tissue. We report the first case of multiple gastric and duodenal ulcerations due to Strongyloides stercoralis in an immunocompetent patient. We suggest that the elevated eosinophil count played a central role in the pathogenesis. 1. Introduction Global prevalence of Strongyloides stercoralis infection is unknown, but it is estimated that more than three million people are infected worldwide. Infected patients usually remain asymptomatic with peripheral eosinophilia or may complain of myriad of symptoms including skin rash due to larval penetration, cough, wheezing, dyspnea, upper abdominal pain, nausea, vomiting, or diarrhea. Strongyloides stercoralis induced gastrointestinal ulcer disease in immunocompromised patients has been well described in the literature but there is only one reported case of a gastric ulcer occurring in an immunocompetent individual due to Strongyloides stercoralis infection. 2. Case Report An 83-year-old male born in Dominican Republic with a past medical history of arterial hypertension and asthma presented with complaint of constant abdominal pain for 5 days prior to admission, located in the epigastric area. The patient denied having any fever, chills, nausea, emesis, or altered bowel movements. Additionally, the patient denied using any inhaled corticosteroids or any other medications. He had recently returned from a trip to the Dominican Republic one week prior to his present admission. Not being able to recall any sick contacts, the patient on physical examination was afebrile with a mildly elevated blood pressure of 142/79？mmHg and a soft abdomen without any tenderness. Initially laboratory examination was remarkable for an elevated white cell count of 18,200/mm3 (normal 4,500–11,000/mm3) with a markedly elevated absolute eosinophil count of 11,466/mm3 (normal 0–700/mm3), while the rest of his laboratory studies were