Журнал клинической и экспериментальной патологии

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Importance of Multiple Stool Specimens Evaluation by Enzyme Immunoassay in Chronic Giardiasis

Benjamin T Bradley, Miles Mcdonough, Kyi Toe Tham, Matthew M Yeh, and Deepti M Reddi*

Giardiasis is a common cause of enteric parasitic infection. In the duodenum, histologic findings similar to those
of celiac disease are seen in giardia infection. Here, we present a patient with polyclonal hypergammaglobulinemia,
dermatitis herpetiformis, celiac disease and chronic giardiasis. The patient is a 51-year-old man, who was incidentally
found to have a high serum total protein and low albumin levels. The protein electrophoresis showed polyclonal
hypergammaglobulinemia and beta gamma bridging. With an elevated erythrocyte sedimentation rate the patient’s
stool was evaluated and was positive for giardia lamblia cysts. The patient failed to respond to the ten-month treatment
of Metronidazole, Tinidazole, and Nitazoxanide; and developed a pruritic and blistering maculopapular rash that
was diagnosed as dermatitis herpetiformis. Also he was diagnosed with celiac disease with an elevated IgA antitransglutaminase
antibody (56.7 units/mL) and was responsive to gluten-free diet.
Then patient was lost to follow-up for 5 months, and later presented with abdominal pain. The patient underwent
endoscopy that showed duodenal mucosa with fissuring and an irregular villous pattern. The patient’s fecal specimen
was negative for Giardia specific antigens by ProSpecT Giardia Microplate Enzyme Immunoassay, with manufacture
reported sensitivity of 99.2% and specificity of 99.6%.