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An Unexpected Etiology for Abdominal Pain and Diarrhea in an Argentinian Immigrant

FIGURE 2. Stomach biopsy, hematoxylin and eosin stain. A, Adult worm of S. stercoralis. B, Larval form. CASE HISTORY A 75-year-old immigrant woman from Argentina with history of chronic lymphocytic leukemia was recently diagnosed with retinal toxoplasmosis and was initiated on antitoxoplasmosis treatment along with steroid therapy, 1 mg/kg of prednisone per day. She presented in our hospital 1 week prior with febrile illness, maximum temperature of 102°F and headache. The cerebrospinal fluid analysis showed a positive India ink stain, and the culture confirmed Cryptococcus neoformans infection. One week into her hospitalization, she complained of abdominal pain, had decreased appetite, and had an episode of nonbilious emesis and nonbloody diarrheal bowel movements. Her temperature was 99.8°F. On physical examination, there was epigastric tenderness to deep palpation with normoactive bowel sounds. White blood cell count was 9600 cells/mm with 56% polymorphonuclear cells, 23% lymphocytes with 12% blasts, and 2% eosinophils. The stool ova and parasites are shown in Figure 1. The patient first underwent a radiographic small bowel series which showed gastritis, duodenititis