E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis.
1Department of Internal Medicine, Guillermo Almenara Irigoyen National Hospital, Lima, Peru.
Abstract
Introduction.
Spontaneous Escherichia coli meningitis is an infrequent condition in
adults and is associated with some predisposing factors, including
severe Strongyloides stercoralis (SS) infections. Case Presentation. A
43-year-old Hispanic man, with history of travelling to the jungle
regions of Peru and Brazil two decades ago, and who received prednisone
due to Bell's palsy for three weeks before admission, presented to the
Emergency Department with diarrhea, fever, and hematochezia. A week
after admission he developed drowsiness, meningeal signs, abdominal
distension, and constipation. A cerebrospinal fluid culture showed
extended spectrum β -lactamase producing E. coli. A colonoscopy was
performed and showed pancolitis. Three days after the procedure the
patient became unstable and developed peritoneal signs. He underwent a
laparotomy, which ended up in a total colectomy and partial proctectomy
due to toxic megacolon. Three days later the patient died in the
intensive care unit due to septic shock. Autopsy was performed and
microscopic examination revealed the presence of multiple Strongyloides
larvae throughout the body. Conclusion. Strongyloides stercoralis
infection should be excluded in adults with spontaneous E. coli
meningitis, especially, if gastrointestinal symptoms and history of
travelling to an endemic area are present. Even with a proper diagnosis
and management, disseminated strongyloidiasis has a poor prognosis.
Case Rep Infect Dis. 2013;2013:424362. doi: 10.1155/2013/424362. Epub 2013 Nov 13.
http://www.hindawi.com/journals/criid/2013/424362/
Md. MSc. Yvan Maque. Ex-miembro del GII.