Suvajdzic N, Kranjcić-Zec I, Jovanović V, Popović D, Colović M
Institute of Hematology, Clinical Center of Serbia, Belgrade, Yugoslavia.
Haematologia (Budap). 1999;29(4):323-6.
A patient with chronic idiopathic thrombocytopenia and fatal strongyloides hyperinfection syndrome following prolonged corticosteroid therapy is briefly described. Diagnosis was difficult to perform due to absence of eosinophilia and diarrhea at presentation, as well as to the negativity of multiple stool specimens examined by direct microscopy of saline smear, formol-ether concentration techniques, and Baermann's test. The striking hypoalbuminemia in the setting of the normal results of liver function tests and prothrombin time was assumed to be due to enteropathy. Therefore, an upper endoscopy was undertaken, revealing Strongyloides stercoralis (SS) larvae in the biopsy specimens of the gastric and duodenal mucosa. The SS larvae were also demonstrated in the multiple specimens of the concentrated sputum. Despite thiabendazol treatment, death ensued. On autopsy, SS larvae were recovered in the gastrointestinal tract and lungs. The importance of early diagnosis and of ruling out strongyloidosis prior to administration of corticosteroids are discussed, as well as the pathogenetic aspects of strongyloidosis in the patient under corticosteroids.
简要描述了一名患有慢性特发性血小板减少症的患者，在长期接受皮质类固醇治疗后出现致命的类圆线虫重度感染综合征。由于患者就诊时无嗜酸性粒细胞增多和腹泻，且通过生理盐水涂片直接显微镜检查、甲醛乙醚浓缩技术和贝曼氏试验检查的多个粪便标本均为阴性，因此诊断困难。在肝功能试验和凝血酶原时间结果正常的情况下出现的显著低白蛋白血症被认为是由于肠病所致。因此，进行了上消化道内镜检查，在胃和十二指肠黏膜活检标本中发现了粪类圆线虫幼虫。在多个浓缩痰液标本中也发现了粪类圆线虫幼虫。尽管使用了噻苯达唑治疗，但患者仍死亡。尸检时，在胃肠道和肺部发现了粪类圆线虫幼虫。讨论了早期诊断以及在使用皮质类固醇之前排除类圆线虫病的重要性，以及该患者在使用皮质类固醇情况下类圆线虫病的发病机制。
