Multiple small intestinal helminthiasis (trichuriasis and tapeworm) diagnosed by capsule endoscopy – a case report

Introduction: Chronic small intestinal helminthiasis is a rare gastrointestinal disorder, usually diagnosed by means of eosinophilia and detection of eggs during stool examination. However, the lack of these typical clinical signs could make the diagnosis nearly impossible.

Case report: A 23 years old male patient was investigated in our department due to intermittent diarrhea, diffuse abdominal pain, anorexia, weight loss (15kg) and mild anemia. Physical examination and routine laboratory tests were normal, including sedimentation, abs. eosinophil cell number (0.07 G/l), CRP, Fe, TVK, TSH, and HIV antibody. Serial stool bacteriology and parasitic examinations including helminthes eggs and Giardia PCR were all repeatedly negative. Small bowel biopsy demonstrated normal villous architecture. Total colonoscopy with multiple biopsy excluded colonic abnormality. Nutritive allergy, celiac sprue (EMA) was excluded. After having negative abdominal ultrasound, double contrast upper GI series and abdominal CT scan, a capsule endoscopy was performed, which detected isolated small bowel helminthiasis. Serum IgG ELISA test against Tenia solium detected high level of antibodies. Finally, the patient was treated with praziquantel then albendazole. During praziquantel therapy stool examination demonstrated Hymenolepis nana and Trichuris trichiuria eggs. After specific therapy he became asymptomatic and gain 5 kgs of weight.

Discussion: Trichuris trichiuria (whipworm) is an intestinal nematode while Hymenolepis nana belongs to the tapeworms family. Infection of both helminth cause relatively mild tissue reactions. However anorexia, weight loss and diarrhea are typical symptoms. In our case the diagnosis was only possible by means of capsule endoscopy.