We report a 49-year-old man who was a human
T-cell leukemia virus type 1 (HTLV-1) carrier, born in Okinawa prefecture where both
strongyloidiasis and HTLV-1 are endemic. He presented with
fever,
headache and
urinary retention. On the basis of CSF examination and MRI findings, his condition was diagnosed as
myelitis. He received
methylprednisolone pulse
therapy. He was transferred to our hospital due to severe
paralytic ileus. Strongyloides stercoralis (S. stercoralis) was found in the duodenal stained tissue of a biopsy specimen.
Ivermectin applied both orally and through
enema were ineffective because of severe
ileus and intestinal
bleeding. Nine mg (200 microg/kg) of
ivermectin solution was administered subcutaneously every other day for five days (total amount 45 mg). The S. stercoralis burden in the stool decreased and
paralytic ileus gradually resolved. Three weeks after the resolution of S. stercoralis
infection, purulent
meningitis developed and acute
obstructive hydrocephalus appeared. The
hydrocephalus improved by ventricular drainage. Approximately three months after drainage, he died of incidental aspiratory
pneumonia. Autopsy showed neither eggs nor larvae of S. stercoralis in the organs. In this case, the fourth reported case in the world, subcutaneous
ivermectin injection was dramatically effective. We should consider a diagnosis of
strongyloidiasis for any patient from Okinawa prefecture who was an HTLV-1 carrier presenting with unknown origin
ileus after treatment of
steroid therapy.