TWiP 112: A NOD to a tricky helminth

June 25, 2016

t_trichiura_adult_femaleHosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiP trio solve the case of the Woman from Washington Heights, and reveal how helminth infection protects mice deficient in the Crohn’s disease gene NOD2 from intestinal disease by inhibiting colonization with an inflammatory bacterial species.

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Case Study for TWiP 112

A case here at CUMC, 59 yo male, past medical history of childhood polio, presents with worsening lower extremity weakness, bowel and urinary incontinence. 2 year before worsening back pain, weakness, could not work. Cannot walk up one flight of stairs since 1 month; 1 week prior to admission had fever, no headaches, diarrhea, cough, or any other symptoms. Splits time between Washington Heights and Mexico. Construction worker. Rural town in southern Mexico, 10 months of the year. Worked in the corn growing area. Has been exposed to bugs. Stopped working in cornfields 20 years ago. Has son and daughter, visits them. Lives with wife, stays in Mexico, she is fine. HIV negative. Eats home prepared foods, no dietary restrictions. Physical exam: not febrile, vital signs all good, neurological: upper strength good, weakness in hip flexors, ⅗; quadriceps, but ⅕ in lower extremities ⅖ in right. Sensory has decreased as well. Possibly spinal lesion. Labs: elevated glucose, ESR 33, CRP 2.2, whites 8, 30.6 hematocrit, guaiac negative. Imaging: MRI of spine shows normal vertebrae, T9/10 inflammation of spinal cord, mass lesion, compromise of canal. Brain MRI: hydrocephalus. Problem with recirculation of CSF.

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