Strongyloidiasis masquerading as Addison’s disease

Abstract

Abstract A 20-year-old man presented with complaints of weight loss of 25 kg, anorexia, vomiting, and generalized darkening of complexion for 6 months. He complained of abdominal discomfort, fullness, and pain after meals, followed by vomiting. There was no history of diarrhea, fever, night sweats, or jaundice. The stools were not bulky or oily. He was hospitalized before, but nothing significant was found except for mucosal thickening in the stomach and duodenum in gastroscopy. His chest X-ray, thyroid function tests, plasma glucose, and abdominal sonography were found normal during the previous admission. Serology for HIV was nonreactive. Family history was noncontributory. The patient had no addictions. The patient was shifted to the endocrine ward with a suspected diagnosis of Addison’s disease. The patient looked cachexic, with sunken eyes and coarse hair. However, serum 8 a.m. cortisol was normal. But vitamin B12 was low. The patient belonged to a rural background and was going to fields for defecation. His stool examination showed larvae of Strongyloides. After antihelminthic drugs, he showed improvement in appetite and regained 24 kg of weight in the next 4 months. Skin complexion also became normal.