The serpiginous urticarial rash is caused by rapid (approximatelly 15 cm/h) moving of Strongyloides stercoralis larvae from the anal area down the upper thighs [3, 12]. Duodenal obstruction is an extremely rare complication of strongyloidiasis, with eight cases reported in the medical literature. Table 1 summarizes all the reported cases of duodenal obstruction caused by Strongyloides SP600125 nmr stercolaris since 1970 [9, 13–18]. Two mechanisms have been implicated in the duodenal obstruction due to S. stercoralis. First, the obstruction would be related to a severe mucosal edema and

inflammation with significant narrowing of duodenal lumen. Second, an extrinsic compression of the duodenum by the superior mesenteric neurovascular bundle could be responsible for the obstructive symptoms. Several mechanisms are proposed to explicate

the extrinsic duodenal compression (i.e. superior mesenteric artery/Wilkie’s Syndrome) in patients with strongyloidiasis, including severe weight loss, duodenal distention, mesenteric lymphatic dilation, and increase in the diameter of superior mesenteric vessels [15, 16, 19]. Table 1 Literature review of duodenal obstruction caused by Strongyloides stercoralis infection (1970-2010). Author Year Age Gender Country Associated disease WBC/eosinophils Surgery Diagnosis PND-1186 treatment Outcome Cohen & Spry13 1979 40 M England lymphoma 16.500/4% SB resection DA, EGD+bx thiabendazole * Dead Zyngier et al.14 1983 30 M Brazil no NR/0% gastrojejunostomy GA, sputum thiabendazole † Alive Lee & Terry15 1989 15 M Jamaica no 4.400/NR no stool analysis Selleck KPT-8602 thiabendazole ‡ Alive   1989 19 F Jamaica no 10.000/NR no DA thiabendazole Alive Friedenberg et al.16 1999 40 M USA HTLV-1 infection 35.500/1% no EGD+bx thiabendazole Dead Harish et al.9 2005 45 M

India no 12.000/14% no DA, Calpain EGD+bx ivermectin Alive Suvarna et al.17 2005 70 M India no 11.000/(220/μL) no EGD+bx ivermectin # Alive Juchems et al.18 2008 63 M Germany no 10.500/NR partial gastrectomy surgical specimen ivermectin Alive Current case 2010 42 F Brazil no 14.900/0% duodenal resection surgical specimen ivermectin + albendazole Dead NR, not reported; WBC, white blood cell count; DA, duodenal aspirate; GA, gastric aspirate; EGD, esophagogastroduodenoscopy; SB small bowel; bx, biopsy; HTLV-1, Human T-lymphotropic virus Type I * small bowel resection after medical treatment for strongyloidiasis showed poorly differentiate small bowel lymphoma † patient underwent to a gastrojejunostomy; diagnosis was made after surgery by EGD + gastric aspirate ‡ patient presented new episode of duodenal obstruction 6 years after the initial treatment/recurrent strongyloidiasis # initially treated with albendazole without success. Paralytic ileus is also a potential complication of S. stercolaris hyperinfection [7, 11, 20–23]. In a recent review, Yoshida et al.