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Eosinophilic appendicitis due to Strongyloides stercoralis: a challenging differential diagnosis for clinicians
  1. Javier Páramo-Zunzunegui1,2,
  2. Laura Rubio-López1,
  3. Silvia Benito-Barbero1 and
  4. Ángeles Muñoz-Fernández3
  1. 1Department of General and Digestive Surgery, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
  2. 2Department of Surgery, Rey Juan Carlos University, Madrid, Spain
  3. 3Department of Histopathology, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
  1. Correspondence to Dr Javier Páramo-Zunzunegui; javier.paramo{at}


A 45-year-old man presents with 48-hour status of high temperature, cough and dyspnoea. In the context of pandemic, the patient is initially diagnosed with COVID-19 syndrome. Later, the laboratory and ultrasound study supported acute appendicitis diagnosis. Appendicectomy was performed. The histopathology study confirmed eosinophilic appendicitis and that a parasitic infection was suspected. The stool sample was positive for Strongyloides stercoralis. The diagnosis of a S.stercoralis is a rare finding in Spain. S. stercoralis simulates clinical findings of inflammatory bowel disease or eosinophilic gastroenteritis, which may lead to the wrong therapeutic choice. Since in inflammatory diseases corticosteroid treatments are considered the initial choice in many cases, in the case of S. stercoralis infection, the administration of this therapy can be fatal. In Spain, the number of diagnoses is much lower than in the past decade, although it is highly probable that the infection has been underdiagnosed due to low clinical awareness among Spanish population.

  • infectious diseases
  • infection (gastroenterology)
  • medical management

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  • Contributors JP-Z: Idea, writing and contributor who accepts full responsibility for the finished article. MF-A: Figures. BB-S: Writing. RL-L: Identification and treatment of the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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