E-Poster Abstract No: ABS004: Strongyloidiasis masquerading as Addison’s disease

“

TL;DR

A 20-year-old man with weight loss, vomiting, and generalized hyperpigmentation was initially suspected to have Addison's disease, but normal serum cortisol ruled this out. Stool examination revealed Strongyloides larvae, and after antihelminthic treatment, he regained 24 kg of weight and his skin complexion normalized. This case highlights that strongyloidiasis can mimic Addison's disease and should be considered in patients with hyperpigmentation and gastrointestinal symptoms, especially in endemic areas.

Full summary

2,279 CHARS

**Background:** Strongyloidiasis is a parasitic infection caused by Strongyloides stercoralis, which can present with a variety of symptoms including gastrointestinal and dermatological manifestations. Addison's disease (primary adrenal insufficiency) is characterized by hyperpigmentation, weight loss, and gastrointestinal symptoms. This case report describes a patient whose strongyloidiasis mimicked Addison's disease, emphasizing the importance of considering parasitic infections in the differential diagnosis.

**Methods:** This is a case report of a 20-year-old man who presented with complaints of weight loss of 25 kg, anorexia, vomiting, and generalized darkening of complexion for 6 months. He also had abdominal discomfort, fullness, and pain after meals followed by vomiting. There was no history of diarrhea, fever, night sweats, or jaundice. He had been hospitalized previously, where gastroscopy showed mucosal thickening in the stomach and duodenum, but chest X-ray, thyroid function tests, plasma glucose, and abdominal sonography were normal. HIV serology was non-reactive. Family history was non-contributory, and the patient had no addictions. He was shifted to the endocrine ward with a suspected diagnosis of Addison's disease. On examination, he looked cachexic, with sunken eyes and coarse hair. However, serum 8 AM cortisol was normal. Vitamin B12 was low. The patient belonged to a rural background and was going to fields for defecation.

**Key Results:** Stool examination showed larvae of Strongyloides. After treatment with antihelminthic drugs, the patient showed improvement in appetite and regained 24 kg of weight over the next 4 months. His skin complexion also became normal.

**Clinical Implications:** This case demonstrates that strongyloidiasis can present with hyperpigmentation, weight loss, and gastrointestinal symptoms, closely mimicking Addison's disease. A normal serum cortisol level helped rule out adrenal insufficiency. In patients from endemic areas with appropriate risk factors (e.g., rural background, soil contact), strongyloidiasis should be considered in the differential diagnosis of hyperpigmentation and wasting. Prompt diagnosis and treatment with antihelminthic therapy can lead to complete resolution of symptoms.