Strongyloides Stercoralis Infection: A Rare Cause of Acute Abdomen

A 30-year-old female presented to the emergency department with severe recurrent abdominal pain, nausea, vomiting and a 50-pound unintentional weight loss within the past few years. After emigrating from Liberia to the United States in 2005, the patient was evaluated for similar complaints in the past and underwent exploratory laparotomies and partial small bowel resection with no significant improvement in symptoms. Computerized tomography (CT) of the abdomen showed intestinal inflammation and mesenteric edema. Small intestinal enteroscopy was unremarkable. Small intestinal biopsy showed larval round worms in intestinal crypts. Stool ova and parasite exam revealed larval forms of Strongyloides stercoralis. She was treated with ivermectin 200 mcg/kg daily for two days and recommended to return in four weeks to repeat stool exam to ensure complete parasite clearance.