title: [Fulminant strongyloidiasis successfully treated by subcutaneous ivermectin: an autopsy case].
abstract: 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.
authors.affiliation: Department of Neurology, Miyazaki Prefectural Hospital of Nobeoka.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Takashima
authors.forename: Shogo
authors.initials: S
authors.lastname: Yazawa
authors.forename: Akira
authors.initials: A
authors.lastname: Ishihara
authors.forename: Sei-ichiro
authors.initials: S
authors.lastname: Sugimoto
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Shiomi
authors.forename: Kenji
authors.initials: K
authors.lastname: Hiromatsu
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Nakazato
mesh_terms: D000977:Antiparasitic Agents / Q000008:administration & dosage*; D001344:Autopsy; D006800:Deltaretrovirus Infections / Q000150:complications; D017809:Fatal Outcome; D015368:Human T-lymphotropic virus 1; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D045823:Ileus / Q000209:etiology; D007279:Injections, Subcutaneous; D007559:Ivermectin / Q000008:administration & dosage*; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology; D008775:Methylprednisolone / Q000009:adverse effects; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects; D012720:Severity of Illness Index; D013322:Strongyloidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000977:Antiparasitic Agents; D007559:Ivermectin; D011239:Prednisolone; D008775:Methylprednisolone