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Am Fam Physician. 1999;60(8):2238

to the editor: I am concerned that readers might be confused by a last-minute editorial change made in Question 3 in the June 1999 “Clinical Quiz” (page 2974), pertaining to my article “Case Studies in International Medicine.”1 The question, “Which one of the following should be considered a clue to the presence of a Strongyloides infection?” is classified as having only one correct answer (choice A, “perianal or buttock urticaria”). However, I believe answer E, as changed by the editors, is also a correct choice.

I had originally listed option E as “improvement after treatment with pancreatic enzymes,” which would make this an incorrect answer; improvement with pancreatic enzyme administration can be expected if the patient has tropical pancreatitis, but generally not if the patient has strongyloidiasis. However, the answer for option E was changed by the editors to “weight loss.” Although it is true that weight loss is not one of the “classic” symptoms of strongyloidiasis (perianal/buttock urticaria, abdominal pain and diarrhea), weight loss may occur in patients heavily infected with Strongyloides. Therefore, even though the best choice remains A, “perianal or buttock urticaria,” option E is also correct.

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