[Long-term damage to duodenal mucosa in malabsorption syndrome as a sequela of Giardia lamblia infection].

A 35-year-old German woman presented after a three month journey to Sudan with intermittent, persistent watery diarrhea. Stool examination identified Giardia lamblia. The patient was unsuccessfully orally treated with metronidazol 250 mg three times a day for seven days and tinidazol 2 g as single dose. During a two week hospitalization we observed a total villous atrophy in a duodenal biopsy specimen in absence of celiac sprue or a immunodeficiency syndrome. We treated with metronidazol 500 mg three times a day intravenously and discharged the patient in good condition. This case report shows the variability of clinical presentation of infection with Giardia lamblia. Moreover, we demonstrate rarely found histological changes as reason for clinical presentation, unsuccessful oral treatment and malabsorption. The intravenous therapy lead to a permanent eradication of Giardia lamblia.