Flare-up of ulcerative colitis after systemic corticosteroids: a strong case for Strongyloides.

Abstract

Super-imposed infection with intestinal organisms can mimic a flare-up of underlying disease in patients with inflammatory bowel disease (IBD). We report a case of patient with long standing ulcerative colitis (UC), who presented with abdominal pain, diarrhea and low-grade fever after receiving systemic corticosteroids for an unrelated disorder. Despite a negative stool examination, a peripheral eosinophilia reappeared upon tapering down of a corticosteroid dose. Subsequently, duodenal biopsies showed evidence for Strongyloides, presumably acquired 20 years ago when the patient was residing in Brazil. The patient fully recovered following anti-helmintic therapy. This case underscores the importance of considering Strongyloides in the work-up of flaring-up IBD patients, even if a history of residing or traveling to endemic areas is in the distant past.

• Authors: Shomron Ben-Horin, Iris Barshack, Yehuda Chowers, Meir Mouallem
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 14 Issue 27 Pg. 4413-5 (Jul 21 2008) ISSN: 1007-9327 [Print] United States
• PMID: 18666337 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Antiparasitic Agents

Topics

• Adrenal Cortex Hormones (adverse effects, pharmacology)
• Animals
• Antiparasitic Agents (pharmacology)
• Biopsy
• Brazil
• Colitis, Ulcerative (diagnosis, drug therapy, parasitology)
• Diagnosis, Differential
• Duodenum (parasitology, pathology)
• Eosinophilia
• Humans
• Male
• Middle Aged
• Strongyloides (pathogenicity)