{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T20:10:04Z","timestamp":1723061404929},"reference-count":19,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,10,7]]},"abstract":"<jats:p>A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia\/melena requiring &gt; 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 <jats:sc>am<\/jats:sc> cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of <jats:italic>Strongyloides stercoralis<\/jats:italic>, indicating <jats:italic>Strongyloides<\/jats:italic> hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection.<\/jats:p>","DOI":"10.4269\/ajtmh.15-0355","type":"journal-article","created":{"date-parts":[[2015,7,21]],"date-time":"2015-07-21T02:35:16Z","timestamp":1437446116000},"page":"822-827","source":"Crossref","is-referenced-by-count":6,"title":["Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease"],"prefix":"10.4269","volume":"93","author":[{"given":"Brittany","family":"Yee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nai-Wen","family":"Chi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence A.","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland R.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hoi-Sang","family":"U","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Savides","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph M.","family":"Vinetz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"PLoS Negl Trop Dis","first-page":"e3018","article-title":"Strongyloidiasis\u2014an insight into its global prevalence and management","volume":"8","author":"Puthiyakunnon","year":"2014"},{"key":"ref2","series-title":"J Int Assoc Physicians AIDS Care (Chic)","first-page":"235","article-title":"Strongyloides stercoralis hyperinfection in a patient with AIDS","volume":"8","author":"Bava","year":"2009"},{"key":"ref3","series-title":"World J Gastroenterol","first-page":"6401","article-title":"Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding","volume":"12","author":"Csermely","year":"2006"},{"key":"ref4","series-title":"Gastrointest Endosc","first-page":"738","article-title":"Strongyloides colitis in a patient with Cushing's syndrome","volume":"59","author":"Goh","year":"2004"},{"key":"ref5","series-title":"Clin Microbiol Rev","first-page":"208","article-title":"Strongyloides stercoralis in the immunocompromised population","volume":"17","author":"Keiser","year":"2004"},{"key":"ref6","series-title":"Clin Infect Dis","first-page":"1411","article-title":"Strongyloidiasis in transplant patients","volume":"49","author":"Roxby","year":"2009"},{"key":"ref7","series-title":"Asian Pac J Trop Med","first-page":"331","article-title":"Overt gastrointestinal bleeding because of hookworm infection","volume":"5","author":"Chen","year":"2012"},{"key":"ref8","series-title":"N Engl J Med","first-page":"799","article-title":"Hookworm infection","volume":"351","author":"Hotez","year":"2004"},{"key":"ref9","series-title":"Am J Trop Med Hyg","first-page":"97","article-title":"Seroepidemiology of strongyloidiasis in the Peruvian Amazon","volume":"74","author":"Yori","year":"2006"},{"key":"ref10","series-title":"South Med J","first-page":"750","article-title":"Strongyloides hyperinfection syndrome complicating (ectopic) Cushing syndrome","volume":"101","author":"Vadlamudi","year":"2008"},{"key":"ref11","series-title":"Clin Microbiol Rev","first-page":"595","article-title":"History of human parasitology","volume":"15","author":"Cox","year":"2002"},{"key":"ref12","series-title":"Arch Intern Med","first-page":"1005","article-title":"Disseminated Strongyloides stercoralis infection. Association with ectopic ACTH syndrome and depressed cell-mediated immunity","volume":"138","author":"Cummins","year":"1978"},{"key":"ref13","series-title":"Gastrointest Endosc","first-page":"170","article-title":"Strongyloidiasis: new endoscopic findings","volume":"42","author":"Choudhry","year":"1995"},{"key":"ref14","series-title":"Clin Microbiol Infect","first-page":"543","article-title":"Novel approaches to the diagnosis of Strongyloides stercoralis infection","volume":"21","author":"Buonfrate","year":"2015"},{"key":"ref15","series-title":"Am J Trop Med Hyg","first-page":"535","article-title":"Diagnostic accuracy of Kato-Katz, FLOTAC, Baermann, and PCR methods for the detection of light-intensity hookworm and Strongyloides stercoralis infections in Tanzania","volume":"90","author":"Knopp","year":"2014"},{"key":"ref16","series-title":"J Clin Gastroenterol","first-page":"203","article-title":"Intestinal strongyloidiasis: recognition, management, and determinants of outcome","volume":"39","author":"Concha","year":"2005"},{"key":"ref17","series-title":"Clin Infect Dis","first-page":"1040","article-title":"Diagnosis of Strongyloides stercoralis infection","volume":"33","author":"Siddiqui","year":"2001"},{"key":"ref18","series-title":"Am J Trop Med Hyg","first-page":"477","article-title":"A comparative trial of a single-dose ivermectin versus three days of albendazole for treatment of Strongyloides stercoralis and other soil-transmitted helminth infections in children","volume":"55","author":"Marti","year":"1996"},{"article-title":"Parasites: Strongyloides","year":"2012","author":"Centers for Disease Control and Prevention","key":"ref19"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/93\/4\/article-p822.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/93\/4\/article-p822.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/93\/4\/article-p822.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T19:00:40Z","timestamp":1723057240000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/93\/4\/article-p822.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,7]]},"references-count":19,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.15-0355","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2015,10,7]]}}}