Ramdial Pratistadevi K, Hlatshwayo Ndabuko H, Singh Bhugwan
Department of Pathology, Nelson R Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu Natal & Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu Natal 4058, South Africa.
Ann Diagn Pathol. 2006 Aug;10(4):209-14. doi: 10.1016/j.anndiagpath.2005.11.008.
Mesenteric lymph node involvement in Strongyloides stercoralis hyperinfective states, described as an autopsy finding, remains a relatively poorly recognized and possibly underreported, antemortem phenomenon. Furthermore, the occurrence of S stercoralis mesenteric lymphadenopathy as a tocsin of bowel strongyloidiasis and the clue to the cause of intestinal pseudo-obstruction are undescribed. We report S stercoralis mesenteric lymphadenopathy and intestinal pseudo-obstruction in 5 HIV seropositive male patients, 21 to 42 years, who presented with abdominal pain and variable vomiting, diarrhea, and constipation. All were pale, pyrexial, and emaciated with abdominal distension. The preoperative diagnosis was intestinal obstruction. Poor clinical response on conservative therapy necessitated laparotomy. Dilated small bowel loops, ascites, and mesenteric lymphadenopathy were consistently noted; a diagnosis of pseudo-obstruction due to underlying tuberculosis or lymphoma was made. The mesenteric lymph nodes were biopsied. The pertinent nodal features were a dense infiltrate of eosinophils, eosinophil microabscesses and degranulation, a focal Splendore-Hoeppli phenomenon, and randomly disposed, but elusive, S stercoralis filariform larvae. Clinical deterioration confirmed intestinal complications at repeat laparotomy. Intestinal resections were performed in 4 patients; histopathologic appraisal confirmed intestinal strongyloidiasis. All patients died within 3 to 7 days after surgery. Heightened awareness of S stercoralis mesenteric lymphadenopathy as a sentinel of intestinal strongyloidiasis and etiopathogenetic clue of intestinal pseudo-obstruction may allow timely diagnosis and medical treatment and avoidance of further surgery, potentially reducing the long-term morbidity associated with S stercoralis hyperinfection.
粪类圆线虫高度感染状态下的肠系膜淋巴结受累，作为一项尸检发现，仍然是一种相对未被充分认识且可能生前报告不足的现象。此外，粪类圆线虫肠系膜淋巴结病作为肠道类圆线虫病的警示信号以及肠道假性梗阻病因线索的情况尚未见描述。我们报告了5例年龄在21至42岁的HIV血清阳性男性患者出现粪类圆线虫肠系膜淋巴结病和肠道假性梗阻，这些患者表现为腹痛、伴有不同程度的呕吐、腹泻和便秘。所有患者均面色苍白、发热且消瘦，伴有腹胀。术前诊断为肠梗阻。保守治疗临床反应不佳，因此需要进行剖腹手术。术中持续观察到小肠袢扩张、腹水和肠系膜淋巴结病；诊断为潜在结核或淋巴瘤导致的假性梗阻。对肠系膜淋巴结进行了活检。相关的淋巴结特征为嗜酸性粒细胞密集浸润、嗜酸性粒细胞微脓肿和脱颗粒、局灶性Splendore - Hoeppli现象，以及随机分布但难以发现的粪类圆线虫丝状蚴。再次剖腹手术时临床病情恶化证实了肠道并发症。4例患者进行了肠切除术；组织病理学评估证实为肠道类圆线虫病。所有患者在手术后3至7天内死亡。提高对粪类圆线虫肠系膜淋巴结病作为肠道类圆线虫病哨兵以及肠道假性梗阻病因线索的认识，可能有助于及时诊断和治疗，避免进一步手术，从而潜在降低与粪类圆线虫高度感染相关的长期发病率。
