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

World J Gastroenterol. 2008 Jul 21;14(27):4413-5. doi: 10.3748/wjg.14.4413.

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.

Publication types

  • Case Reports

MeSH terms

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

Substances

  • Adrenal Cortex Hormones
  • Antiparasitic Agents