58 yo female complaining of joint pains, inflammatory, with mouth and cutaneous lesions in favor of Behcet disease. Recently, she has stomach pain, and weight loss. Gastro-duodenal endoscopy is performed.

Patiente de 58 ans se plaignant d'arthralgies d'allure inflammatoire, avec aphtose buccale plaques rythmato-purpuriques, en faveur d'une Maladie de Behcet. Devant une altration de l'tat gnral avec amaigrissement rcents, et pigastralgie, une gastro-duodnoscopie est ralise.

The intestinal villous architecture is absent on the duodenal biopsy at low power. At close up, rounded and elongated bodies are noted in the crypts.

Higher power on these structures.

These bodies are parasites, rounded worms, elongated, showing on sections their digestive apparatus.

DIAGNOSIS: Strongyloidiasis

The nematode Strongyloides stercoralis is known to be a common source of infection in Third World countries, is now recognized to be common in certain parts of the United States, and may be endemic in institutions.The infection may remain dormant and subclinical for many years. It is especially important to diagnose and treat this infection prior to institution of immunosuppressive therapy. Otherwise, an overwhelming fatal infection may follow. Gastrointestinal symptoms, if present, are usually mild, with only minimal change in villous architecture. Occasionally, heavy infestations may be T-associate with a severe lesion of villous architecture and related severe malabsorption. The primary mode of diagnosis is stool examination, although serologic testing is an adjunct. Sometimes the diagnosis is made on the basis of small bowel biopsy or biopsy from other parts of the gastrointestinal tract. The possibility of endemic strongyloidiasis should always be considered in patients who have unexplained high eosinophilic count.