This case describes a man in his 70s with a history of multiple myeloma and multiple healthcare encounters for diarrhea in the previous five years, which had always been attributed to viral or unknown causes, without any microbiologic or serologic testing. The patient was admitted to the hospital with gastrointestinal symptoms and diagnosed with cholecystitis and gangrenous gallbladder. Two months after his admission for cholecystitis, he was readmitted for severe vomiting and hypotension. An upper gastrointestinal endoscopy with biopsy unexpectedly showed that his duodenum was heavily infiltrated with a parasitic helminth (worm) called Strongyloides stercoralis. He was treated with the anti-parasitic drug ivermectin and eventually improved enough to be discharged from the hospital. The commentary summarizes factors contributing to the missed diagnosis of strongyloidiasis, potential consequences of a failure to diagnose this infection, and approaches to identify patients who should be tested for Strongyloides infection.
- Provider:University of California, Davis, Health System
- Activity Link: https://psnet.ahrq.gov/web-mm/strongyloides-hidden-traveler-and-potentially-lethal-missed-diagnosis
- Start Date: 2022-12-14 06:00:00
- End Date: 2022-12-14 06:00:00
- Credit Details: AMA PRA Category 1 Credit™️: 1.0 hours
- MOC Credit Details: ABIM - 1.0 Point; Credit Type(s): Medical Knowledge (ABIM)
ABIM - 1.0 Point; Credit Type(s): Patient Safety (ABIM) - Commercial Support: No
- Activity Type: Enduring Material
- CME Finder Type: Online Learning
- Fee to Participate: No, it's free
- Measured Outcome: Learner Competence, Learner Knowledge
- Provider Ship: Jointly Provided
- Registration: Open to all
- Specialty: Internal Medicine
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