背景:类圆线虫结肠炎是一种严重的类圆线虫病,如果不治疗,死亡率很高。类圆线虫结肠炎和克罗恩病之间存在重叠的临床表现。这里,我们介绍一例患者,该患者被诊断为克罗恩病,并接受免疫抑制剂治疗,结果不良.
方法:中年人,非洲本土男性出现腹泻,腹痛,和减肥。结肠镜检查显示盲肠有斑片状炎症,活检提示克罗恩病。在因腹痛入院之前,他服用了短暂的类固醇疗程,腹泻,营养不良,和严重的减肥。最初的保守治疗失败,他身体严重不适,患有腹膜炎。进行了剖腹手术,回肠末端有轻度炎症,没有切除。术后,患者昏迷并进入多器官功能障碍.他没有进步,术后第12天再次进行剖腹手术和结肠次全切除术.他的多器官衰竭进展,4天后他死了.
结论:类圆圆线虫是一种在动物和人类中引起肠道感染的寄生虫。免疫能力强的个体中的肌萎缩线虫病通常是一种惰性疾病。然而,在免疫受损的个体中,会导致过度感染综合症.对于嗜酸性粒细胞性结肠炎患者,应进行结肠镜检查和活检,其中嗜酸性粒细胞浸润的急性炎症表明结肠壁有寄生虫浸润。一般不需要手术,任何误诊为IBD发作的手术干预对患者都是非常有害的。
结论:类圆样结肠炎可以非常有害地模拟克罗恩氏结肠炎,使用类固醇和免疫抑制剂会传播寄生虫感染。过度感染综合征可导致败血症,器官功能障碍,和逗号。播散性感染具有很高的死亡率。
BACKGROUND: Strongyloides colitis is a severe form of strongyloidiasis that carries a high mortality rate if untreated. There is an overlapping clinical presentation between Strongyloides colitis and Crohn\'s disease. Here, we present a
case of a patient who was diagnosed with Crohn\'s disease and was treated with immunosuppressant therapy which resulted in a poor outcome.
METHODS: A middle-aged, native African male presented with diarrhea, abdominal pain, and weight loss. Colonoscopy showed some patchy inflammation in the caecum, which on biopsy was suggestive of Crohn\'s disease. He had a short course of steroids before being admitted to an emergency with abdominal pain, diarrhea, malnutrition, and severe weight loss. Initial conservative treatment failed, and he became acutely unwell and septic with peritonitis. Laparotomy was carried out, which showed mild inflammation in the terminal ileum, which was not resected. Postoperatively, the patient became comatose and went into multi-organ dysfunction. He failed to progress, and a further laparotomy and subtotal colectomy were performed on the 12th postoperative day. His multi-organ failure progressed, and he succumbed to death 4 days later.
CONCLUSIONS: Strongyloides stercoralis is a parasite causing an enteric infection in animals and humans. Strongyloidiasis in immunocompetent individuals is usually an indolent disease. However, in immunocompromised individuals, it can cause hyperinfective syndrome. Patients with strongyloid colitis should undergo colonoscopy and biopsy where acute inflammation with eosinophilic infiltrates indicates parasitic infiltration of the colonic wall. Surgery is generally not indicated, and any surgical intervention with misdiagnosis of a flare-up of IBD can be very detrimental to the patient.
CONCLUSIONS: Strongyloid colitis can very harmfully mimic Crohn\'s colitis, and the use of steroids and immunosuppressants can disseminate parasitic infection. Hyperinfection syndrome can lead to sepsis, organ dysfunction, and comma. Disseminated infection carries a high mortality.