Image 30: This young Canadian male, born in the Caribbean, presented with a three week history of nausea, vomiting and weight loss. His abdominal CT showed thickening of the small bowel wall and mesenteric adenopathy. A laparoscopy revealed a thickened edematous small bowel and a mesenteric node biopsy revealed "strange objects". The diagnosis was:         case/images from  C. Greenaway, McGill University

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Image 30. The strange objects were cross sections of strongyloides larvae, and the diagnosis was disseminated strongyloides. The duodenum and ileum were discolored and edematous. Many strongyloides larvae were found in stool, the pleural space and the sputum. (ref: Keiser PG, Nutman TB Clin Microbiol Rev 17:208-217, 2004) What is a common Caribbean immunocompromizing agent that can lead to disseminated strongyloides? The answer is
(Case published Turner et al. Am J Trop Med Hyg 2005 73: 911-914)

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Image 30:  HTLV1. This patient was HTLV1 positive. (Ref. Gotuzzo EA et al: Amer J Trop Med 60: 146-149, 1999)