title: 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.affiliation: Gastroenterology Department, Sheba Medical Center, Tel-Hashomer 52621, Israel. sben-horin@013.net.il
authors.forename: Shomron
authors.initials: S
authors.lastname: Ben-Horin
authors.forename: Iris
authors.initials: I
authors.lastname: Barshack
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Chowers
authors.forename: Meir
authors.initials: M
authors.lastname: Mouallem
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000494:pharmacology*; D000818:Animals; D000977:Antiparasitic Agents / Q000494:pharmacology; D001706:Biopsy; D001938:Brazil; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000188:drug therapy* / Q000469:parasitology*; D003937:Diagnosis, Differential; D004386:Duodenum / Q000469:parasitology / Q000473:pathology; D004802:Eosinophilia; D006801:Humans; D008297:Male; D008875:Middle Aged; D013321:Strongyloides / Q000472:pathogenicity*
chemical_list: D000305:Adrenal Cortex Hormones; D000977:Antiparasitic Agents