ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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A Rare Case of Common Biliary Duct Dilation and Acute Pancreatitis Caused by Hookworm Infestation
Session Title
TP58 - TP058 INFECTIONS IN THE ICU: CASE REPORTS
Abstract
A2949 - A Rare Case of Common Biliary Duct Dilation and Acute Pancreatitis Caused by Hookworm Infestation
Author Block: T. Jahir1, R. Risal1, B. Shrestha1, R. Pata1, S. Hossain2, S. Frances1; 1Medicine, Interfaith Hospital Medical Center, Brooklyn, NY, United States, 2Medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States.
Introduction: Hookworms (mainly Ancylostoma duodenale and Necator americanus) cause helminthic gastrointestinal tract disease and affect an estimated 576-740 million people worldwide. Hookworms are prevalent in countries with poor hygiene and sanitation. The incidence of hookworm infections is increasing in the USA due to increasing numbers of immigrants from endemic countries and increased travel to endemic countries. While the majority of hookworm infections are asymptomatic or cause anemia, hookworms can rarely invade the biliary tract to cause an obstruction and acute pancreatitis.Case Description: A 67-year-old woman who had recently migrated from Bangladesh presented to the emergency department with a four-day history of 7/10 colicky, non-radiating, right upper quadrant (RUQ) pain with fever, watery diarrhea, nausea, and vomiting. She was febrile, tachycardic, and hypotensive on arrival with pale conjunctiva, RUQ tenderness, and guarding. Routine blood tests revealed normocytic anemia, neutrophilic leukocytosis, eosinophilia, hypoalbuminemia, mildly elevated aspartate transaminase, elevated alkaline phosphatase, and elevated lipase. Abdominal CT illustrated descending and transverse colon wall thickening consistent with acute colitis and a 12 mm dilated common bile duct (CBD). She was admitted to the critical care unit with a diagnosis of severe sepsis due to acute colitis with pancreatitis. Cultures and stool samples were negative for blood, ova, cysts, parasites, Clostridium difficile, and calprotectin, and Helicobacter pylori. CEA, AFP, and CA 19-9 tests were negative. The abdominal sonogram was unremarkable however hepatobiliary scintigraphy showed a delay in the visualization of the CBD and distension suggesting partial CBD obstruction; which was confirmed by MRCP revealing dilated CBD with a dilated pancreatic duct; ERCP confirmed worms in the duodenum and CBD. Histopathological analysis of duodenal biopsies revealed lamina propria inflammation and parasites consistent with hookworm. The patient was discharged on ivermectin and with a follow-up endoscopic ultrasound, and her symptoms completely resolved. Discussion: This case highlights that hookworms are an uncommon cause of biliary obstruction and very rarely cause acute pancreatitis. Despite choledocholithiasis being the most common cause of CBD dilatation and pancreatitis, duodenal and biliary tree parasitosis due to hookworm infection should also be considered in the differential diagnosis, especially if the patient is an immigrant from an endemic region.
Author Block: T. Jahir1, R. Risal1, B. Shrestha1, R. Pata1, S. Hossain2, S. Frances1; 1Medicine, Interfaith Hospital Medical Center, Brooklyn, NY, United States, 2Medicine, Jamaica Hospital Medical Center, Jamaica, NY, United States.
Introduction: Hookworms (mainly Ancylostoma duodenale and Necator americanus) cause helminthic gastrointestinal tract disease and affect an estimated 576-740 million people worldwide. Hookworms are prevalent in countries with poor hygiene and sanitation. The incidence of hookworm infections is increasing in the USA due to increasing numbers of immigrants from endemic countries and increased travel to endemic countries. While the majority of hookworm infections are asymptomatic or cause anemia, hookworms can rarely invade the biliary tract to cause an obstruction and acute pancreatitis.Case Description: A 67-year-old woman who had recently migrated from Bangladesh presented to the emergency department with a four-day history of 7/10 colicky, non-radiating, right upper quadrant (RUQ) pain with fever, watery diarrhea, nausea, and vomiting. She was febrile, tachycardic, and hypotensive on arrival with pale conjunctiva, RUQ tenderness, and guarding. Routine blood tests revealed normocytic anemia, neutrophilic leukocytosis, eosinophilia, hypoalbuminemia, mildly elevated aspartate transaminase, elevated alkaline phosphatase, and elevated lipase. Abdominal CT illustrated descending and transverse colon wall thickening consistent with acute colitis and a 12 mm dilated common bile duct (CBD). She was admitted to the critical care unit with a diagnosis of severe sepsis due to acute colitis with pancreatitis. Cultures and stool samples were negative for blood, ova, cysts, parasites, Clostridium difficile, and calprotectin, and Helicobacter pylori. CEA, AFP, and CA 19-9 tests were negative. The abdominal sonogram was unremarkable however hepatobiliary scintigraphy showed a delay in the visualization of the CBD and distension suggesting partial CBD obstruction; which was confirmed by MRCP revealing dilated CBD with a dilated pancreatic duct; ERCP confirmed worms in the duodenum and CBD. Histopathological analysis of duodenal biopsies revealed lamina propria inflammation and parasites consistent with hookworm. The patient was discharged on ivermectin and with a follow-up endoscopic ultrasound, and her symptoms completely resolved. Discussion: This case highlights that hookworms are an uncommon cause of biliary obstruction and very rarely cause acute pancreatitis. Despite choledocholithiasis being the most common cause of CBD dilatation and pancreatitis, duodenal and biliary tree parasitosis due to hookworm infection should also be considered in the differential diagnosis, especially if the patient is an immigrant from an endemic region.
