Gastric strongyloidiasis as multiple small gastric nodules

BACKGROUND Strongyloidiasis, a common intestinal parasitic infection, is endemic in tropical and subtropical regions and occurs sporadically in temperate areas. It is endemic in Guilan province, Iran, and especially affects the rural population. CASE REPORT We report the case of a 43-year-old woman living in Anzali (in the north of Iran), with dyspepsia and epigastric pain for 2 years, unresponsive to H2 receptor antagonists and proton pump inhibitors. Upper gastrointestinal endoscopy was done and showed multiple small nodules at the stomach. The pathologist reported Strongyloides. Treatment with Ivermectin and antibiotic triple therapy was done. She responded well to treatment and 6 months later an upper gastrointestinal endoscopy revealed no significant lesions and all nodules had disappeared. Strongyloidiasis is usually not severe and frequently is nonspecific. For this reason, the infection is easily ignored by both the patients and physicians. CONCLUSIONS Although gastric involvement shows nonspecific symptoms, the possibility should be carefully considered by clinicians who practice in endemic areas.