A rare combination of eosinophils and pancreatic tumor

L.B. Vrolijk, L.C.J Te Boome, L.E. Perk

Woensdag 20 april 2016

15:30 - 15:40u in Zaal 0.4

Categorie├źn: Parallelsessie

Parallel sessie: Parallelsessie 3: Case reports/research

Case: A 62 years old patient from Surinam presented with a pancreatic tumor, found by coincidence on CT-scan. His medical history included CABG, diabetes and hypertension. His cardiologist ordered a CT-scan to evaluate the aortal diameter because of a biscupid aortic valve. The scan showed a tumor in the pancreas sized 55x65x55 mm. Apart from unexplained chronic back pain he had no complaints. Physical examination revealed no abnormalities. Laboratory investigation showed leucocytes 11,0x10^9/L and eosinophilic granulocytes 1,07 - 2,02x10^9/L over time, other laboratory tests were normal. Endoscopic ultrasound showed a well demarcated hypo echogenic tumor without local lymphadenopathy. A fine needle biopsy was performed in this same session. Histological examination showed an eosinophilic pancreatitis and treatment was started with prednisone.

After that additional tests were performed to analyze the eosinophilia, to exclude auto immune- and bone marrow diseases and serum test for Strongyloides, which was strongly positive although the stool testing for ova en parasites was negative. He was treated with a single dose of ivermectine. Eosinophilia resolved, repeated ultrasound after three months showed an unchanged tumor.

Discussion: A pancreatic tumor is a very unusual manifestation of Strongyloides infection. Only 3 cases have been published in immunocompentent patients. One of these cases describes a very slow resolving of the pancreatic tumor during a period of three years after treatment of Strongyloides.

In patients presenting with a pancreatic tumor and eosinophilia, Strongyloides infection should be taken into account in differential diagnosis, even if the stool is negative for Strongyloides.