1. Two Cases of Strongyloidiasis Diagnosed by Colonoscopic Biopsy Department of Pathology Kyungpook National University Hospital Sang-Chul Nam, In-Soo Suh, Han-Ik Bae

2. Clinical History Case1 M/63 Weight loss (18kg) for 2 months Anorexia, postprandial discomfort, diarrhea... Personal & Past Hx : Unremarkable Case2 F/73 Melena Intermittent abdominal pain, fever, chill... Hypertension for 3 years Arthritis Asthma (wheezing) : Steroid treatment for 5 months

3. Case1 (M/63) -Mucosal hyperemia, petechiae at ascending, transverse, & descending colon -0.5cm sized polyp at ascending colon. - No definite lesion - Diffuse whitish mucosal discoloration at antrum. Colonoscopic biopsy Gastric endoscopy

4. Colonoscopic finding (S-99-1010)

5. Upper GI Endoscopy (S-99-1276)

6. Case 2 (F/73) -Polyp and petechiae at ascending colon. - Diffuse mucosal hyperemia at antrum and body Colonoscopic biopsyGastric endoscopy

7. Colonoscopy (S-04-9217)

8. S-04-9217, PAS D-PAS Giemsa

10. Upper GI Endoscopy

11. Upper GI Endoscopy - (S-04-9704)- S-04-9704, bulb, H&E 2nd portion, H&E 2nd portion, PAS 2nd portion, D-PAS

13. Rhabditiform Larvae of Strongyloides Stercolaris bc : buccal cavity es : esophagus gp : genital primordia

14. 1.Indirect cycle (Free-living) - Sexual reproduction 2. Direct cycle (Parasitic): - Longstanding parturition after mating - Parthenogenesis Gastric antrum Life Cycle

15. Treatment Must be treated even in the asymptomatic state. (potential for fatal autoinfection) Thiabendazole (25mg/kg, b.i.d) for 2 days but, disseminated strongyloidiasis is 5 to 7 day Steroid treatment is contraindication, because of fatal systemic infection

16. Summary Symptoms; Wheezing (Asthma), melena, anorexia, diarrhea, fever, chill, postprandial discomfort  dramatically disappeared after treatment No definite evidence of endoscopy; manifested by colitis Histopathology of Colonic biopsy; Autoinfection Chronic granulomatous inflammation Filariform larvae (200-300 x 10-20 um) in eosinophilic abscess and/or in capillary Hyperplastic polyp, due to longstanding chronic colitis Confirmed by upper GI endoscopy; Fundus and esophagus; no adult worm. Antrum and duodenum; Adult female pregnant worm (rhabditiform larvae -300-600 x 10-20 um in glands). Usually, no definite inflammatory reaction