NEW YORK (Reuters Health) – A middle-aged, alcoholic woman developed severe pancolitis that was ultimately traced to Strongyloides that she had been exposed to 27 years earlier, according to a case report in the June 16th issue of The Lancet.

The 49-year-old patient was hospitalized at Radboud University Nijmegen Medical Centre in The Netherlands following 1 to 3 weeks of vomiting, profuse diarrhea, abdominal cramps, fever, and reduced consciousness. She could not stand upright because of her pain, and her entire abdomen was extremely tender to palpation.

The patient was born in Surinam, and emigrated to The Netherlands when she was 22 years old, Dr. Astrid Oude Lashof and colleagues note. She had a raised white cell count, normocytic anemia, and elevated levels of C-reactive protein and liver enzymes. CT showed inflammation of the entire colon. Colonoscopy revealed small yellow mucosal lesions in the sigmoid colon, rectum, and terminal ileum.

Examination and testing of biopsy material and stool specimens were negative for pathogenic viruses and bacteria.

Only after a specialized test, the Baermann technique, was S. stercoralis identified. The Baermann technique relies on the ability of the parasite’s larvae to migrate. Feces are wrapped in a porous fabric, such as cheesecloth, and suspended in water at the top of a vessel. The larvae migrate out into the water and sink to the bottom of the vessel, where they can be removed and examined microscopically.

The diagnosis of S. stercoralis was supported by ELISA detection of IgG1 and IgG4 antibodies against strongyloides.

The patient was given one dose of the anthelmintic drug ivermectin 200 µg/kg for 1 day and discharged.

Six weeks later she was asymptomatic and free of the parasite. At her last examination in 2007, she remained asymptomatic.

The authors believe she had harbored S. stercoralis without symptoms since before she left Surinam, a region where the parasite is widespread. Her immunocompromised condition, brought about by chronic alcohol abuse and malnutrition, allowed the infection to manifest.

They recommend that S. stercoralis be considered in patients with compromised immune systems who have lived in areas where the worm is endemic. "The absence of eosinophilia does not exclude chronic strongyloidiasis," they add.