Lethal hematochezia dueto abdominal angiostrongylosis

Abstract

A four-year old native indian girl from Carurú (Vaupés). a sylvatic area of 2.000 inhabitants, near the Colombian border with Brazil. presented with relapsing hematochezia and syncope and died four days iater in Mitú (70°. 10'. 24"" WL; 01°, 11', 54"" NL), despite of several blood transfusions. The blood count showed neither leukocytosis nor eosinophilia. The postmortem examination revealed two masses of 3-4 cm in diameter, located at the distal ileum which on light microscopy showed a severe inflammation of the whole intestinal wail. rich in eosinophils, and giant cell granulomas surrounding and phagocytizing eggs and larvae of Angystrongylus costaricensis. which was also seen in the submucosal arteries, vessels that displayed thickening of the intima and granulomatous inflammation foci with eosinophilia. This is the second angiostrongylosis case from this region; the first one was in a 34-year old native indian woman also with anemia due to hematochezia. Abdominal angiostrongylosis was diagnosed for the first time in Colombia in 1979 in a 5-year old boy from Dagua (Valle). Our case is the sixth patient diagnosed with this disease in Colombia. Hernatochezia as a predominant manifestation of angiostrongylosis rarely occurs. It has been previously reported oniy on three occassions. The great number of eosinophilic Charcot-Leyden crystals present in the intestinal wall infiltrates also stains very well either with the Ziehl-Neelsen or Fite-Faraco stains; we suggest that its search in fecal smears might be of great aid in the diagnosis of suspected cases, since A. cosfarfcensis eggs and larvae are not eliminated in human feces and, consequently, its final diagnosis is frequently histopathological. We reviewed the clinical, parasitological and histopathological characteristics of this parasitosis whose prevalence will probably increase in Colombia as physicians, specially pathologists, get to know it better.