<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452021000400279</article-id>
<article-id pub-id-type="doi">10.1159/000514015</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Strongyloides stercoralis with Gastroduodenal Involvement and Complicated with SIADH: An Inusual Diagnosis to Consider in Immunosuppressed Patients with Hyperemesis and Eosinophilia]]></article-title>
<article-title xml:lang="pt"><![CDATA[S. stercoralis com envolvimento gastroduodenal complicado com SIADH: um diagnóstico incomum a considerar em doentes imunocomprometidos com vómitos e eosinofilia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Alcázar]]></surname>
<given-names><![CDATA[María del Mar Díaz]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Robles]]></surname>
<given-names><![CDATA[Adelina García]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hidalgo]]></surname>
<given-names><![CDATA[Javier Luis López]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Fuentes]]></surname>
<given-names><![CDATA[Dolores Quintero]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Maldonado]]></surname>
<given-names><![CDATA[Alicia Martín-Lagos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Universitario Clínico San Cecilio UGC Aparato Digestivo ]]></institution>
<addr-line><![CDATA[Granada ]]></addr-line>
<country>Spain</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Universitario Clínico San Cecilio Unidad Provincial de Anatomía Patológica de Granada ]]></institution>
<addr-line><![CDATA[Granada ]]></addr-line>
<country>Spain</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>08</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>08</month>
<year>2021</year>
</pub-date>
<volume>28</volume>
<numero>4</numero>
<fpage>279</fpage>
<lpage>283</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452021000400279&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452021000400279&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452021000400279&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Strongyloides stercoralis is an intestinal nematode that colonizes and reproduces in the upper small intestinal mucosa. Infection in immunocompetent hosts is self-limited but in immunocompromised patients it can be complicated and cause hyperinfection. We present a 60-year-old female who was admitted due to an exacerbation of acquired thrombotic thrombocytopenic purpura requiring high doses of corticosteroids. The patient began to experience persistent pyrosis, nausea, vomiting, and oral intolerance. She was di agnosed with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Upper endoscopy was performed and showed esophageal, gastric, and duodenal mucosa with edema and erythema. Moreover, there were superficial erosions and thickened folds in duodenum. Gastric and duodenal biopsies were taken. Abdominal computed tomography and magnetic enteroresonance displayed duodenal dilation and inflammatory changes. The histological study of biopsies showed colonization by S. stercolaris in the antrum and duodenum. S. stercolaris is a human parasite that is endemic in tropical, subtropical, and temperate regions. Its lifecycle is complex because it completes its entire cycle within the human host; it penetrates the skin, migrates to the lungs, and reach the gastrointestinal tract. The most affected site is the duodenum and upper jejunum. The lifecycle includes autoinfection through the intestinal mucosa or perianal skin, especially in immunocompromised hosts. Immunossuppression can lead to hyperinfection syndrome and disseminated disease. However, involvement of the stomach has relatively rarely been reported. SIADH has been related to systemic hyperinfection, although the mechanism is not clear. The relatively nonspecific clinical and imaging features and the low sensitivity of routine parasite tests make the diagnosis challenging and delayed.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: Strongyloides stercoralis é um nematódo intestinal que coloniza e se reproduz na mucosa do intestino delgado proximal. A infeção em hospedeiros imunocompetentes é auto-limitada mas em doentes imunocomprometidos pode ter um curso complicado e causar hiperinfeção. Apresentamos um caso de uma mulher de 60 anos que é admitida devido a uma exacerbação de uma púrpura trombocitopénica trombótica adquirida com necessidade de altas doses de corticoides. A doente inicia quadro de pirose persistente, náuseas, vómitos e intolerância alimentar. Faz-se o diagnóstico de síndrome de secreção inapropriada de hormona antidiurética (SIADH). A endoscopia digestiva alta evidencia mucosa gástrica e duodenal com edema e eritema, para além de erosões e pregas espessadas duodenais. O TC e a enteroRMN mostram dilatação duodenal e alterações inflamatórias. A histologia mostra S. stercoralis a colonizar a mucosa do antro e duodeno. O S. stercolaris é um parasita humano, endémico em regiões tropicais e subtropicais. Tem um ciclo de vida complexo já que completa o seu ciclo todo dentro do organismo humano: penetra pela pele, migra para os pulmões e atinge o trato gastrointestinal. Os sítios mais afetados são o duodeno e o jejuno proximal. O ciclo de vida envolve autoinfeção na mucosa intestinal ou pele perianal, especialmente em doentes imunocomprometidos, com a imunodepressão podendo levar a síndrome de hiperinfeção e doença disseminada. Contudo, o envolvi mento gástrico é raramente descrito. O SIADH tem sido relacionado com o síndrome de hiperinfeção, contudo, o seu mecanismo não é claro. O relativo inespecífico quadro clínico e alterações imagiológicas, assim como a baixa sensibilidade dos testes de parasitas de rotina atrasam e fazem o diagnóstico desafiante.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Strongyloides stercoralis]]></kwd>
<kwd lng="en"><![CDATA[Hyperinfection syndrome]]></kwd>
<kwd lng="en"><![CDATA[Hyperemesis]]></kwd>
<kwd lng="en"><![CDATA[Gastric mucosa]]></kwd>
<kwd lng="en"><![CDATA[Syndrome of inappropriate secretion of antidiuretic hormone]]></kwd>
<kwd lng="pt"><![CDATA[Strongyloides stercoralis]]></kwd>
<kwd lng="pt"><![CDATA[Sindrome de hiperinfeção]]></kwd>
<kwd lng="pt"><![CDATA[Hiperemese]]></kwd>
<kwd lng="pt"><![CDATA[Mucosa gástrica]]></kwd>
<kwd lng="pt"><![CDATA[Sindrome de secreção inapropriada de hormona antidiurética]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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