Published January 13, 2015
Alcohol brings out the worst in some people.
For one woman in the Netherlands, years of alcohol misuse topped off with a few weeks of binge drinking brought out a parasitic worm that had been inside of her for more than a quarter-century.
In 2004, a 49-year-old woman was admitted to a hospital in the Netherlands after almost three weeks of vomiting, diarrhea and fever, according to the Case Report in Friday's issue of The Lancet.
The doctors at Radboud University Nijmegen Medical Center began a battery of tests to determine the cause of her illness.
After a full day of testing the woman was diagnosed with colitis - a digestive disease characterized by inflammation of the colon.
This disease is often caused by inflammatory bowel disease, but when that was not the cause, Dr. Astrid Oude Lashof and his team of infectious disease specialists were called in.
"On examination, the patient looked unwell," Lashof and his colleagues wrote in the Case Report. "She had a fever and was unable to stand upright because of her pain."
She had no relevant medical history and took no medications. She was born in Suriname, a small country in northern South America, and moved to the Netherlands when she was 22.
She had only left the Netherlands once for a short trip to Spain, and had certainly not traveled in the time leading up to her illness. But since her illness began, "she had eaten and drunk little, apart from large amounts of alcohol," the doctors noted.
Even more tests reveled larvae of a common parasitic worm, Strongyloides stercoralis, which is endemic to Central and South America and much of Southeast Asia, but is rarely found in Western Europe.
"Although it is a rare diagnosis nowadays in Europe, we specifically looked for Strongyloides and were therefore glad to see this diagnosis confirmed," Lashof said.
This parasite that can live for years inside of a human host and cause no symptoms. The larvae of this parasite caused the woman to get colitis.
"S stercoralis appears likely to present as colitis in patients with cellular immune defects, such as those cause by corticosteroid use and alcoholism," Lashof and his team reported.
The doctors said it was unlikely she picked up the worm in her short vacation to Spain. They figured the woman contracted the parasite in Suriname, more than 27 years earlier. It was only after chronic alcohol misuse and malnutrition that the infestation manifested.
While this disease can be deadly if left untreated, this woman was successfully treated with an anti-parasite medication. “We wish to emphasize that, when patients have lived in areas where S stercoralis is endemic," the authors concluded, "S stercoralis colitis should be included in the differential diagnosis of intestinal inflammation – particularly when the patient is immunocompromised.”
This article was reviewed by Dr. Manny Alvarez.