STRONGYLOIDES-STERCORALIS EOSINOPHILIC GRANULOMATOUS ENTEROCOLITIS

Six patients suffering from an unusual form of colitis produced by Str ongyloides stercoralis hyperinfection are described. In contrast to th e usual Strongyloides hyperinfection syndrome, in which small intestin al and pulmonary manifestations are seen in patients with some forms o f immunodeficiency, the patients described here presented with only a characteristic transmural eosinophilic granulomatous inflammation affe cting mostly the colonic wall and clinically mimicking ulcerative coli tis or Crohn's disease. This Strongyloides eosinophilic granulomatous enterocolitis apparently results from a florid inflammatory response b y eosinophils, histiocytes, and giant cells with formation of granulom as that destroy the larvae entering the colon. This morphologic pictur e differs from that of the well-described hyperinfection syndrome, in which the bulk of the larvae pass through the colonic wall to complete the life cycle, with only a few larvae destroyed in the colon. The pr obable pathophysiologic mechanism of this unusual manifestation of hyp erinfection is discussed based on the anatomic and clinical observatio ns of patients who presented at different stages in the evolution of t heir condition and whose length of follow-up varied.