For some patients infected with strongyloidiasis a colitis may be the sole manifestation.
The patient may be immunocompetent or immunocompromised.
The infection may be persistent or recurrent due to autoinfection.
Clinical findings:
(1) diarrhea
(2) weight loss
(3) microcytic anemia
Colonoscopy:
(1) may show pancolitis or skip inflammation or colitis with distal attenuation
(2) aphthoid ulcerations
Findings in colon biopsies:
(1) eosinophilic infiltrate
(2) relatively intact crypt architecture
(3) frequent involvement of the submucosa
(4) presence of larvae
Testing stool for ova and parasites can be diagnostic. Molecular methods would be most sensitive.
Differential diagnosis:
(1) other forms of colitis, including ulcerative colitis
(2) other intestinal parasitic diseases
The differential diagnosis can be challenging if strongyloides colitis is present along with another form of colitis or parasitic infection. When present in a patient with inflammatory bowel disease it may be mistaken for an exacerbation.
