فهرست مطالب farahnaz bidari zerehpoosh

 Meningiomas constitute a significant proportion of primary intracranial tumors, demanding a nuanced understanding of their radiological features for informed clinical decisions. This prospective study aimed to explore the intricate relationship between magnetic resonance imaging (MRI) findings and the pathological grade of meningiomas to provide insights into their diverse characteristics.

 A cohort of 52 meningioma patients underwent comprehensive MRI evaluations. The study encompassed various aspects of tumor radiology, including location, peritumoral edema severity, tumor margin distinctiveness, bone infiltration, adjacent bone reaction, apparent diffusion coefficient (ADC) patterns, intratumoral calcifications, bleeding within the tumor, vascularization, and tumor enhancement.

 The analysis revealed that 73.1% of patients presented with grade 1 meningioma, while 26.9% exhibited grade 2 tumors, with no grade 3 cases detected. Intriguingly, while age and gender did not significantly differ between grades, several MRI findings demonstrated noteworthy distinctions. Grade 2 meningiomas were associated with moderate to severe peritumoral edema, indistinct tumor margins, increased vascularization, and heterogeneous tumor enhancement patterns. Notably, logistic regression analysis indicated that none of the investigated radiological parameters independently predicted the pathological grade of meningioma.

 These findings emphasize the need for a comprehensive meningioma assessment approach, integrating radiological insights into clinical decision-making and prognosis for enhanced patient care.

Amyloidosis is a rare disease characterized by the extracellular deposition of a misfolded protein in multiple organs. Cutaneous amyloidosis (CA) is diagnosed by detecting amyloid deposition in the skin. Lichen amyloidosis (LA) and macular amyloidosis (MA) without visceral involvement are two of its more prevalent types. This case-control study was conducted to evaluate C4d staining in amyloidosis to determine whether it could be used as a diagnostic tool for amyloidosis. Moreover, the results of C4d expression in amyloidosis with colloid bodies in lichen planus (LP) were compared. Therefore, 41 cases of CA and 43 cases of LP were selected. All samples were stained with C4d immunostain. 12 of 41 cases of CA had apple green birefringence; however, all of them were positive for C4d, the same as the LP group. The CA group had 100% C4d and 29% Congo red sensitivities (P < 0.05). C4d had 100% sensitivity for colloid bodies in LP. Therefore, the C4d stain could serve as a new IHC marker for highlighting the colloid bodies. C4d immunohistochemical (IHC) staining could be a very valuable ancillary tool for diagnosing amyloidosis, although it did not differentiate amyloid deposition from colloid bodies of LP.

Rowell syndrome (RS) is a disorder characterized by the occurrence of erythema multiforme-like lesions (EM) coexisting with lupus erythematosus. It may be considered a rare subtype of lupus-specific skin lesions. Here we report a clinical presentation of RS in a 34-year-old woman with diagnosed systemic lupus erythematosus (SLE), and without any cutaneous lesion previously that presented with skin lesions and fever. Clinical, laboratory, and histopathology assessments confirmed the diagnosis of RS in the context of SLE flare-up. She was treated with methylprednisolone 1g IV daily for 3 days, then continued with oral Prednisolone, Hydroxychloroquine, and Mycophenolate mofetil. Over treatment Skin’s lesions and oral ulcers subsided gradually and disappear all skin lesions after a month, without a scar.

Aging process leads to changes in the oral mucosa and more than 50% of head and neck cancers occur in older adults. This study aimed to assess the frequency of oral and maxillofacial neoplasms in the Iranian geriatric population.

The record files of the oral pathology department,  Shahid Beheshti University of Medical Sciences, and the pathology departments of Loghman and Imam Khomeini hospitals from 2007 to 2016 served as the source of  material for this retrospective study. Data including patient’s age, gender, tumor  location, and the histopathologic diagnosis were recorded. Chi-Square and one-way  ANOVA tests were used for statistical analysis.

During this period, 551 oral and maxillofacial neoplasms of geriatric  patients were registered in the aforementioned centers. They generally had the highest frequency in the 7th decade of life with a male to female ratio of 1.45. The oral cavity was the commonest location (52%, p=0.000). Out of 551 samples, 95.59% were found in soft tissue and 4.41% in bone. Epithelial tumors were the most common microscopic subtype (56.8%), followed by salivary gland tumors (27.20%). Squamous cell  carcinoma (SCC) was the most common neoplasm (46.50%).

In this study, oral and maxillofacial tumors were most often observed in patients in their 70s with a higher prevalence in male patients. The frequency of cancer was three times that of benign tumors, which emphasizes the need for screening examinations for older adults.

Hashimoto's thyroiditis is a chronic inflammation and an autoimmune disease of the thyroid gland that causes hypothyroidism. Genetic, internal, and environmental factors are the causes of this disease. Because human herpes viruses such as herpesvirus type 6 (HHV-6) are involved in some autoimmune disorders, they may also play a role in causing this disease. This study aimed to evaluate the association between human herpes virus 6 (HHV-6) with Hashimoto's thyroiditis.

In the present study, 64 samples of thyroid paraffin tissue including 32 samples of thyroid paraffin tissue of healthy individuals as control, and 32 samples of thyroid paraffin tissue of Hashimoto's thyroiditis patients were taken from the pathology department of Loghman Hakim Hospital in Tehran. A questionnaire collected demographic information of patients. After DNA extraction from the samples, the nested-PCR technique was performed using specific primers for HHV-6.

Totally, the HHV6-DNA was found in 34.4% of thyroid tissues of healthy individuals (81.8% female and 18.2% male) and 46.9% of patients with Hashimoto's thyroiditis (73.3% female and 26.7% male). It was found that this difference in virus frequency between the two groups was not statistically significant (P value=0.309). There was also no statistically significant relationship between the prevalence of human herpesvirus type 6 and age or sex.

Based on the present study, the number of HHV-6-infected individuals in Hashimoto's patients and controls did not differ significantly; therefore, HHV-6 appears not to be associated with Hashimoto's thyroiditis.

The classification of pituitary adenomas now includes an “atypical” variant, which can be defined as MIB-1 proliferative index greater than 3%, excessive p53 immunoreactivity, invasive growth pattern, and the increased mitotic activity. Recent guidelines do not precisely define the cutoff points for elevated mitotic activity. Therefore, this study was designed to obtain reliable cut-off values for the mitotic index.

In this study, the authors reviewed the records belonged to 300 patients including 250 patients with typical pituitary adenoma and 50 patients with atypical pituitary who were referred to Loghman Hakim Hospital between 2011 and 2017. Statistical analyses were performed using Fisher’s exact test and Mann Whitney. Also, Cut-off values were attained using ROC analysis.

In APAs group, 47.8% and 52.2% of the tumors were microadenomas and macroadenomas, respectively. 91.3% of the patients with APAs had Ki-67 labeling index more than 3%, and the presence of p53 protein was observed in all the patients with APAs. The mean number of mitosis in the TPAs and APAs groups was 0.62 and 2.5, respectively. In addition, our results showed significant threshold values for mitotic index (>2 mitosis within 10 high power fields). Also, there was no significant difference between the size of tumors and type of secretion hormones in the APA and TPA groups (P> 0.05).

We introduced a new cut-off for the mitosis index (greater than 2) that may help to more reliable diagnosis of atypical adenomas (APA). These findings will convince pathologists to adopt this clinicopathological classification, and those clinicians will consider it as helpful when choosing the appropriate therapeutic strategy.

Gastrointestinal (GI) tract is the most common site for extranodal lymphoma. The primary GI lymphoma pattern in Iran is different from western countries and has been changed during the past 40 years.

This study was done to determine the clinical and pathological characteristics of primary GI lymphoma in Tehran, Hamedan, and Mashhad regions in Iran.

In this cross-sectional comparative-descriptive study, 200 patients with primary GI lymphoma in Tehran, Hamadan, and Mashhad regions from 2011 to 2016 were enrolled in a consecutive manner, where the clinical and pathological characteristics of cases were determined.

Among 200 patients, 141 (70.5%) subjects were male and 59 (29.5%) subjects were female. The mean age at diagnosis was 54.3 ± 19.3 years. Also, 84%, 8.5%, and 7.5% of the patients’ specimens were from Tehran, Hamedan, and Mashhad, respectively. The stomach was the principal involved location in approximately half of the cases. Diffuse large B-cell lymphoma (DLBCL), was the main subtype that was observed in 64% of the cases. Treatment in 72% of cases was a combination of surgery and chemotherapy. The 5-year survival was assessed in 147 patients with a rate of 68%.

Primary GI lymphoma is seen more in male subjects younger than 60 years of age with non-specific symptoms. Also, DLBCL and MALToma are the main histologic types, and the 5-year survival for all cases is 68.0%. The clinical symptoms showed no specific pattern and accordingly, patients with weight loss and abdominal pain should be considered in in differential diagnosis of malignant lymphoma.

The scientific evidence concerning pathogenesis and immunopathology of the coronavirus disease 2019 (COVID-19) is rapidly evolving in the literature. To evaluate the different tissues obtained by biopsy and autopsy from five patients who expired from severe COVID-19 in our medical center.

This retrospective study reviewed five patients with severe COVID-19, confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and imaging, to determine the potential correlations between histologic findings with patient outcome.

Diffuse alveolar damage (DAD) and micro-thrombosis were the most common histologic finding in the lung tissues (4 of 5 cases), and immunohistochemical (IHC) findings (3 of 4 cases) suggested perivascular aggregation and diffuse infiltration of alveolar walls by CD4+ and CD8+ T lymphocytes. Two of five cases had mild predominantly perivascular lymphocytic infiltration, single cell myocardial necrosis and variable interstitial edema in myocardial samples. Hypertrophic cardiac myocytes, representing hypertensive cardiomyopathy was seen in one patient and CD4+ and CD8+ T lymphocytes were detected on IHC in two cases. In renal samples, acute tubular necrosis was observed in 3 of 5 cases, while chronic tubulointerstitial nephritis, crescent formation and small vessel fibrin thrombi were observed in 1 of 5 samples. Sinusoidal dilation, mild to moderate chronic portal inflammation and mild mixed macro- and micro-vesicular steatosis were detected in all liver samples.

Our observations suggest that clinical pathology findings on autopsy tissue samples could shed more light on the pathogenesis, and consequently the management, of patients with severe COVID-19

Germinoma is a rare lesion found commonly in the pineal and suprasellar regions of the brain. Clinical presentation mainly involves the location and size of the tumor and the patient age. Endocrine abnormalities are the most common symptom.

The patient was a 26-year-old Iranian female who suffered from germinoma for a long time and was referred to Loghman Hakim Hospital for amenorrhea, polyuria, and polydipsia. Despite diagnostic challenges, she was finally diagnosed with suprasellar germinoma after endoscopic transsphenoidal surgery, followed by radiotherapy and medical interventions to complement the surgery.

It is important to be able to diagnose the patientchr('39')s problem at an early stage based on their history, hormonal profile, laboratory results and radiological view.

Human papillomavirus (HPV) has been associated with prognosis in patients with head and neck squamous cell carcinoma (HNSCC). Similar to the global studies, different prevalence rates of this viral infection have been reported in Iran. Therefore, we aimed to report the prevalence of this virus and its significance in HNSCC patients.

Patients who were referred to the five hospitals of Tehran city from May 2018 to May 2019 were enrolled in this study. All patients were diagnosed with HNSCC based on pathologic study. The pathologic disease staging was defined, and DNAs were extracted from the fresh tissue samples via kits. After polymerase chain reaction (PCR), HPV positive samples were evaluated for determining genotypes and data analysis.

Of the 46 patients, three patients (6.5%) had positive HPV with the following subtypes: 18 (in two patients), 52 (in three patients), 61 (in two patients), 67, and 73. Comparison of variables between the groups with and without HPV showed a significant difference based on the tumor’s lymphatic invasion (p =0.041), peripheral lymph node involvement (p =0.008), and histologic grade (p =0.011), but there was no statistically significant difference in terms of other variables such as age, primary tumor site, size, pathologic stage, vascular or perineural invasion, metastasis, smoking, and alcohol consumption.

HPV positivity is an important factor in the lymphatic invasion, peripheral lymph node involvement, and histologic grade of cases with HNSCC and should be further investigated for its effect on prognosis.

Hepatitis A virus (HAV) is a major cause of acute viral hepatitis throughout the world. The severity of HAV clinical symptoms in infected cases is related to age. Age - specific seroprevalence studies are a reliable method to estimate the susceptibility rate to HAV in populations and can help establish vaccination implementation policies.
In this studyweaimedto determine the age - specificHAVseroprevalenceamon 1 to 23 years subjects residing in Tehran, Iran.
In this cross - sectional study, blood samples of 1120 cases (516 male and 604 female) referred to hospitals’ biochemical laboratories in Tehran, Iran, between the ages of 1 - 23 years were tested for total hepatitis A antibody (anti - HAV) by ELISA. Stratification of the study population was conducted according to age.
The overall prevalence of total anti - HAV was 6% (95% CI: 4.74% - 7.52%). HAV prevalence rates according to age groups were as follows: 5.7% between 1 - 5 years, 1.7% between 6 - 10 years, 4.2% between 11 - 15 years, 5.5% between 16 - 19 years, and 15.3% between 20 - 23 years. Except the 6 - 10 year age group, an increase in HAV seropositivity was observed with age. Anti - HAV seropositivity in terms of age groups was significantly different from each other (P = 0.000). The HAV seroprevalence rate was 32.8% in males and 67.2% in females with a significant difference between genders (P = 0.025).
Our study demonstrates that most young children are susceptible to HAV infection, whereas adolescents and young adults are at more risk for HAV acquisition. Therefore HAV vaccination of young children seems logic and beneficial.

We present a rare case of breast papillary carcinoma associated with intracystic component in a woman with a long history of autoimmune hypothyroidism and multiple sclerosis.
The patient was a 59-year-old woman presented with complaints of pain and swelling in her right breast. She was a known case of autoimmune hypothyroidism since 20 years and secondary progressive multiple sclerosis since 13 years ago. She had received frequent interferon, corticosteroid and cytotoxic therapy for her multiple sclerosis. On imaging studies, there were multiple large cystic-solid lesions in the right breast and with presumptive diagnosis of infectious collection or phyllodes tumor, she finally underwent simple mastectomy. On gross pathological evaluation, a large multi-loculated cyst filled with blood clots and necrotic debris was identified. In serial sections, a 7 cm solid tumoral mass with papillary projections protruding into the cyst cavity was seen. Although the gross appearance of the lesion resembled an angiosarcoma accompanied by cystic hemorrhagic necrosis, after the microscopic evaluation of the specimen, papillary breast carcinoma associated with intracyctic component was finally diagnosed.
The aim of this study was to describe a rare variant of invasive breast cancer presenting with a large solid-cyctic mass in a woman with long standing autoimmune disorders.

Non-Melanoma Skin Cancer (NMSC), the most prevalent types being Squamous Cell Carcinoma (SCC) and Basal Cell Carcinoma (BCC), is the most common type of malignancy in human beings. These neoplasms are more frequent in the elderly and fair skinned people and mainly occur on sun-exposed sites of the body. Ultraviolet B (UVB) has a well-known effect in induction and promotion of growth of these cancers. The p53 tumor suppressor gene is believed to be an early target in UV-induced skin carcinogenesis. Aggregates of keratinocytes with p53 protein overexpression are frequently identified in normal human skin and are more prevalent in chronically sun-exposed skin, and have been proposed to play a role in skin cancer pathogenesis. The aim of this study was to clarify the potential role of P53 in the development of NMSC.
Immunohistochemical evaluation of p53 expression in peri-lesional skin of 90 cases of SCC, BCC and melanocytic nevi was performed.
The well-delineated compact type of p53 clone, but not the strong dispersed type, was significantly more predominant in SCCs in comparison with BCCs and melanocytic nevi (P value=0.001). The size of p53 clones was also significantly greater in SCCs compared to the BCCs (P=0.003) and melanocytic nevi (P=0.001). There was no significant difference between these neoplasms regarding the frequency of P53 clones (P=0.86).
This study suggests the possible relationship of epidermal p53 clones with the pathogenesis of SCC.

Mucoepidermoid carcinoma represents one of the most common malignant salivary gland tumors.However, the sclerosing morphologic variant is extremely rare with only 23 reported cases in the English-language literature since it was discovered in 1987.
Case Report: Herein, we describe another case that was diagnosed in a 25-year-old woman presenting with a posterior auricular mass, as well as a review of the literature, which demonstrates that this is an extremely rare malignancy with no strict protocol for treatment.
Pathologists must be aware of recognizing low grade sclerosing mucoepidermoid carcinoma which has metastatic potential and is frequently misdiagnosed as a benign lesion.

We have presented a rare case of growth hormone (GH) producing pituitary adenoma with lymphocytic infiltration and brain parenchyma invasion. A 37-year-old woman has presented with complaints of headache, amenorrhea and acromegalic features. Her laboratory studies showed markedly elevated levels of Insulin-like Growth Factor 1 (IGF-1), and low levels of follicle stimulating hormone and luteinizing hormone. Computerized tomography has revealed a pituitary mass without extra-sellar extension. The tumor has completely excised via trans-nasal endoscopic approach. Histologically, the tumor has diagnosed as a pituitary adenoma with GH positive cells. The serum IGF1 levels have gradually decreased to the normal range and the patient was symptom free for three and a half years when she has returned with complaint of visual impairment. The brain MRI that time has shown a supra-sellar mass growing independently into the remaining sellar part. Subsequently, surgical operation has performed via trans-nasal endoscopic approach. Histopathological and immunohistochemistry examination have revealed a rare case of growth hormone producing pituitary adenoma with brain invasion and lymphocytic infiltration. The aim of this publication was to present a rare case of growth hormone producing pituitary adenoma with brain invasion and lymphocytic infiltration.

Tuberculosis is now more frequently observed in older individuals, often with underlying illnesses or conditions that may confuse diagnosis. Rapid diagnosis is mandatory. However, treatment should be initiated immediately based on strong clinical suspicion, because mortality from tuberculosis is most often due to delays in treatment.. A 68-year-old male was admitted to our hospital with fever. He had splenomegaly, ascites and right-sided psoas abscess. Chest X-ray was normal. Although the vertebral column was intact, he had asymptomatic sacroiliitis. Bony changes of the right sacroiliac joint seemed to be chronic on computerized tomography (CT) scan. Lack of associated clinical symptoms strengthened this assumption. However, signal alterations of respective areas on magnetic resonance imaging (MRI) suggested active inflammation. Analysis of aspirated pus was positive for acid-fast bacilli and the culture depicted mycobacterial growth. The patient was not cirrhotic yet he had high serum-ascites albumin gradient ascites. He had two hypodense lesions in his liver with a cholestatic pattern in the liver test. He had pancytopenia. Biopsy from his liver and bone marrow showed multiple granulomas. Treatment was started with an anti-tuberculosis regimen of four drugs. He responded well to our therapeutic protocol.. Tuberculosis is still a diagnostic challenge, especially when the presentation is atypical and extra-pulmonary..

Standardization of hospital emergency units is a major goal in developed countries to decrease the duration of patients stay in these units. The present study was undertaken to evaluate the prevalence of long-term staying in an emergency ward. In the present 2-month cross-sectional study, patients referring to the emergency ward of Imam Hossein hospital were assessed. The patients’ demographic data, including age, the presenting symptoms and signs, reasons for delays, and the final outcome in relation to the location of hospitalization and discharge information were recorded. Data were reported as frequencies and percentages. The results were reported as means and standard deviations using SPSS version 20. Of 10087 patients admitted into the emergency ward during a 2-month period, 75 patients (0.7%) needed to stay and wait for more than 24 hours. The mean ± standard deviation of the patients’ ages was 62.5 ± 20.2 years, with 60% of the patients being over 60 years of age. The most common reason for overcrowding in the emergency ward was a lack of empty beds, with the need for ICU beds as the most important reason for bed deficiency in 59% of the cases. Nervous system problems were the most common reasons for referring to the emergency unit (41%) in patients under study. Finally, 81% of the patients were hospitalized, 10% died, 7% were discharged based on personal request and 1.3% were transferred to another hospital. The prevalence of patients staying and waiting in the emergency ward for more than 24 hours was 0.7%. Lack of empty ICU beds was the most important reason for such delays; however, paraclinical problems had no role in these delays which were associated with the death of 10% of patients.

Nevus lipomatosus superficialis (NLS) is a hamartomatous skin lesion defined by the presence of mature adipose tissues among the collagen bundles of the dermis. It is classified into two forms: the classical form and the solitary form. The classical NLS most commonly involves the pelvic or gluteal region. In this paper, we report a case of classical NLS over the neck because of its atypical site. In addition, our patient had some uncommon features of NLS such as the presence of comedo-like lesions on the plaque and a foul-smelling discharge.

CD10 is a cell surface enzyme with metalloendopeptidase activity, also known as Common Acute Lymphoblastic Leukaemia Antigen, which mainly serves as a marker for acute lymphoblastic leukemia (ALL). To date and to the best of our knowledge, only few comparative immunohistochemical studies have assessed CD10 expression in cutaneous epithelial neoplasms. Our goal was to determine whether CD10 can be used in pathologic distinction of cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). This study included 27 BCC and 17 SCC cases immunohistochemically stained for CD10. Cytoplasmic +/- cell membrane staining was considered as positive. Each slide was studied by two pathologists and scored semi- quantitatively as follows: negative (<10%); 1+ (10-50% positive cells); and 2+ (>50% positive cells). The rate of CD10 expression in tumor cells was significantly higher in BCCs in comparison to SCCs. (20/27 vs., 2/17; P <0.0001). Our findings suggest CD10 as a useful adjunct marker in distinguishing cutaneous BCC and SCC.

A 77-year-old Iranian man was visited at the Dermatology Department of Loghman-e Hakim Hospital affiliated with Shahid Beheshti University of Medical Sciences on June 2012 with bilateral, symmetric, raised, violaceous and painless plaques on the nose (both ala nasi), from one year ago. The lesions were small at first and then grew gradually larger in size. Systemic symptoms such as fever, weight loss and night sweat were absent. He had no history of systemic disease, bite, trauma, vaccination, or medication. Past medical history was negative except for cataract in several years ago and he was in good health. He had a history of treatment with oral antibiotics without any improvement. Physical examination revealed bilateral, symmetric, indurated, violaceous, non-tender plaques on the nose (both ala nasi) with some scales and follicular accentuation without discharge (Figure 1). Other examinations were normal and laboratory tests revealed no abnormality. A skin biopsy was performed.

Based on previous studies, cardiovascular diseases, traffic accidents, traumas and cancers are the most important etiology of mortalities in emergency departments (ED). However, contradictory findings have been reported in relation to mortality in emergency departments. Therefore, the present study was undertaken to evaluate the role of clinical factors in mortality among patients referring to an emergency department in a third-level hospital in Tehran, Iran. In the present case-control study, all the patients over 18 years of age were evaluated, referring to the ED of Imam Hossein Hospital, Tehran, Iran, from the beginning of 2009 to the end of 2010. The patients died in the ED were placed in the case group and those discharged or hospitalized in other hospital wards in the control group. Demographic data, background diseases, and the final diagnoses were recorded. Chi-squared test, multivariate logistic regression, and Pearson’s correlation coefficient were used to evaluate the relationship between the variables mentioned above and patient mortality. A total of 2907 patients (969 (59.9% male) in the case and 1938 (62.2% male) in the control groups) were evaluated. Cardiovascular diseases (39.2%), severe traumas (18.5%), and cerebrovascular accidents (17.7%) were the most frequent etiology of patient mortality in ED. Multivariate regression analysis showed that presentation with cardiovascular complaints (OR=7.3; 95% CI: 3.5-16.1; p<0.001), a history of hypertension (OR=5.4; 95% CI: 1.2-12.3; p<0.001), severe trauma (OR=4.6; 95% CI: 2.0-13.2; p<0.001), age over 60 (OR=3.8; 95% CI: 1.8-7.8; p<0.01) and a final diagnosis of renal disease (OR=3.4; 95% CI: 2.1-6.4; p<0.001) were factors that increased the odds of mortality in patients referring to the ED. Multivariate regression analysis in patients over 60 years showed that sepsis was an independent factor increasing the risk of death (OR=2.9; 95% CI: 1.3-5.9; p=0.009). A patient’s risk of death increases with an increase in the number of risk factors in that patient (r2=0.96; p=0.02). It appears the odds of mortality in patients referring to ED with cardiovascular complaints, a history of hypertensive, severe trauma, age over 60 and a final diagnosis of renal disease are higher versus other patients. In addition, the patients’ odds of death increase with an increase in the number of risk factors. Such an increase is more noticeable at age over 60.

Strongyloides stercoralis is a free living tropical and semitropical soil nematode which its larva penetrates skin. It can complete its life cycle in human body and causes autoinfection. Most patients have no frank symptoms. But respiratory, gastrointestinal and skin manifestation may occur. We report a 76 year old man admitted to emergency room with muscle weakness, dyspnea, nausea, vomiting while receiving prednisolone 60 mg/d plus methotrexate 15 mg intramuscular injections per week for his underlying polymyositis. His upper endoscopy showed an ulcer and microscopic examination revealed S. stercoralis larvae and adult worm in gastric mucosa. He was treated with a combination of parenteral ivermectin and oral albendazole, the disease course ended in complete improvement with clearing of daily stool samples after more than 2 weeks of treatment. It is noteworthy that the pre-steroid stool examinations were negative for parasites.