Diagnostic Yield of Double‐balloon Enteroscopy With Intestinal Juice Analysis for Intestinal Strongyloidiasis

Abstract

Strongyloidiasis is relatively common in tropical and subtropical areas. Most patients with Strongyloides stercoralis hyperinfection are immunocompromised, most commonly from corticosteroids or human T-cell lymphoma virus type 1 (HTLV-1) infection. We encountered a patient with HTLV-1 infection accompanied by paralytic ileus, in whom strongyloidiasis in the duodenum and jejunum was disclosed by esophagogastroduodenoscopy (EGD) and double-balloon enteroscopy (DBE). Until the age of 7 years, he lived on Amami-Oshima Island, Japan, where both S. stercoralis and HTLV-1 are endemic. EGD and peroral DBE disclosed white villi, edematous mucosa, and the disappearance of folds in the duodenum and jejunum. Biopsy specimens from the white villi in the duodenum and jejunum revealed S. stercoralis larvae. In both duodenal and jejunal juice, the rhabditiform larvae moved around. Because the larvae invade the lymph vessels, resulting in lymphangiectasia in edematous enteritis, the appearance of white villi may reflect villous atrophy/destruction and mucosal edema. Although our patient revealed no eosinophilia and negative stool specimens for parasites or ova, EGD and DBE with multiple biopsies and intestinal juice analysis are valuable diagnostic tools for strongyloidiasis.

Diagnostic Endoscopy of Intestinal Strongyloidiasis in an Immunocompetent Patient by Single Balloon Enteroscopy

“…In the literature, there is a one report of Strongyloides stercoralis infection diagnosed by video capsule endoscopy in an immunocompetent patient [13] and two published case reports, where the diagnosis of the infection was only made by biopsies obtained with double balloon enteroscopy [14,15].…”