Aphthoid ulceration of the colon in strongyloidiasis

In humans, infestation with Strongyloides stercoralis most commonly involves the upper small intestine. We describe a 65-yr-old woman who presented with abdominal pain, weight loss, and hypoalbuminemia, and was found at colonoscopy to have patchy erythema with aphthoid ulcers scattered throughout the large intestine proximal to the splenic flexure. Biopsy of involved areas and examination of the colonic effluent revealed S. stercoralis larvae. Previous reports of colonic involvement with this nematode, and the differential diagnosis of aphthoid ulcers, a newly described lesion associated with S. stercoralis infestation, are discussed.