[Chronic recurrent subileus due to Strongyloides stercoralis infection under immunosuppressive therapy].
METHODS
A 33-year-old woman from Laos was admitted due to recurrent vomiting and weight loss. Since one year, she was receiving immunosuppressive therapy (azathioprine 50 mg/d and methylprednisolone 18 mg/d) for a mixed connective tissue disease. Because of a drug induced Stevens-Johnson-Syndrome one month earlier high doses of methylprednisolone (100 mg/d intravenously) had been administered. The patient's general condition was reduced. Examination elicited a mild pain in the middle abdomen on palpation but no resistance or tumour. The differential diagnosis included obstructive and (or) inflammatory disease of the gastrointestinal tract.


METHODS
Elevated IgE-levels (1111 IU/ml; normal up to 100 IU/ml) and eosinophilia (8%) lead to the suspicion of a helminthiasis. Oesophagogastroduodenoscopy showed a significant duodenal stenosis. Duodenal biopsy revealed a severe infestation with Strongyloides stercoralis. Stool examinations were negative though.


METHODS
With administration of thiabendazole (2 g/d) a rapid recovery was noted. A second oesophagogastroduodenoscopy one week after the onset of therapy revealed no further stenosis. Since there was no activity of the mixed connective tissue disease the methylprednisolone dosage was reduced and the administration of azathioprine was ceased. 3 weeks after beginning of treatment the patient was discharged in improved condition.


CONCLUSIONS
In immunocompromised patients suffering from gastrointestinal complaints who have been in endemic areas an infection with Strongyloides stercoralis should be excluded. Without treatment, this helminthiasis may be fatal.
Birck
R
R
V. Medizinische Klinik (Nephrologie/Endokrinologie), Fakultät für Klinische Medizin, Universität Heidelberg.
Braun
C
C
Back
W
W
Gottstein
T
T
Rohmeiss
P
P
Manegold
B C
BC
Strauch
M
M
Gretz
N
N
D000328:Adult; D000818:Animals; D001379:Azathioprine / Q000008:administration & dosage*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D004378:Duodenal Diseases / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005858:Germany; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology*; D007812:Laos / Q000208:ethnology; D008775:Methylprednisolone / Q000008:administration & dosage*; D008947:Mixed Connective Tissue Disease / Q000150:complications / Q000188:drug therapy; D012008:Recurrence; D017171:Strongyloides stercoralis; D013322:Strongyloidiasis / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology
D007166:Immunosuppressive Agents; D001379:Azathioprine; D008775:Methylprednisolone
Chronisch-rezidivierender Subileus durch Strongyloides-stercoralis-Infektion unter immunsuppressiver Therapie.