Corsetti M, Basilisco G, Pometta R, Allocca M, Conte D
Chair of Gastroenterology, IRCCS, Ospedale Maggiore, Milan, Italy.
Ital J Gastroenterol Hepatol. 1999 Oct;31(7):607-9.
A 69-year-old male chronic alcohol abuser suffering from diarrhoea and with a number of discrete pruriginous and erythematous lesions of the trunk was referred to our Unit with a diagnosis of idiopathic eosinophilic colitis in order that we might determine corticosteroid treatment. Diagnosis was based on the presence of marked peripheral eosinophilia and massive eosinophilic infiltration at colonic biopsy, and the exclusion of parasitic infection by means of two different microscopic stool examinations of five samples. However, repeated stool examinations of ten samples collected on separate days and evidence of impaired cell-mediated immunity allowed a definite diagnosis of Strongyloides stercoralis autoinfection or hyperinfection. Due to the poor sensitivity of stool examination in the diagnosis of Strongyloides stercoralis infection, a careful search for this parasite should be made in all patients with comparable clinical findings before formulating a diagnosis of idiopathic eosinophilic colitis, because consequent steroid treatment may have a fatal outcome by inducing widespread dissemination of the parasite.
一名69岁的男性慢性酒精滥用者，患有腹泻，躯干有多处散在的瘙痒性红斑病变，因诊断为特发性嗜酸性粒细胞性结肠炎而转诊至我院，以便确定皮质类固醇治疗方案。诊断依据为外周血嗜酸性粒细胞显著增多以及结肠活检显示大量嗜酸性粒细胞浸润，同时通过对五份样本进行两次不同的粪便显微镜检查排除了寄生虫感染。然而，在不同日期采集的十份样本的反复粪便检查以及细胞介导免疫受损的证据，最终确诊为粪类圆线虫自身感染或超感染。由于粪便检查对粪类圆线虫感染的诊断敏感性较差，在诊断特发性嗜酸性粒细胞性结肠炎之前，应对所有有类似临床表现的患者仔细排查该寄生虫，因为后续的类固醇治疗可能会因导致寄生虫广泛播散而产生致命后果。
