Minimal change nephrotic syndrome in a patient with strongyloidiasis.
Strongyloidiasis, a chronic infection caused by the intestinal parasite Strongyloides stercoralis, is prevalent in the Nansei Islands of Japan. Here, we report our findings on a case of strongyloidiasis complicated with steroid-resistant minimal change nephrotic syndrome in a 69-year-old male resident of Fukuoka Prefecture who had lived in Yakushima, one of the Nansei Islands, until age 15. In October 2006, he developed proteinuria and edema, and was diagnosed with minimal change nephrotic syndrome on the basis of the renal biopsy findings. Following treatment with prednisolone, the level of proteinuria decreased to 0.29 g/day by day 35. However, 5 days later (day 40), the patient developed persistent watery diarrhea and vomiting, leading to dehydration and malnutrition. Pneumonia and bacterial meningitis subsequently developed (day 146); filarial (infectious-type) and rhabditiform (noninfectious-type) S. stercoralis larvae were detected for the first time in the patient's sputum, gastric juice, feces, and urine. Although treatment with ivermectin was started immediately and the parasitosis responded to the treatment, the patient died of sepsis. Consequently, although strongyloidiasis is a rare infection except in endemic regions, it is essential to consider the possibility of this disease and begin treatment early for patients who have lived in endemic areas and who complain of unexplained diarrhea during steroid-induced or other immunosuppression.
Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Mieko
M
Miyazaki
Masahito
M
Tamura
Narutoshi
N
Kabashima
Ryota
R
Serino
Tatsuya
T
Shibata
Tetsu
T
Miyamoto
Yumi
Y
Furuno
Tetsuo
T
Nishio
Jiro
J
Ohara
Toshihiro
T
Sakurai
Yutaka
Y
Otsuji
D000368:Aged; D000818:Animals; D000977:Antiparasitic Agents / Q000008:administration & dosage; D001706:Biopsy; D003967:Diarrhea / Q000469:parasitology; D004487:Edema / Q000209:etiology; D017809:Fatal Outcome; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007559:Ivermectin / Q000008:administration & dosage; D007668:Kidney / Q000473:pathology; D008297:Male; D009402:Nephrosis, Lipoid / Q000188:drug therapy / Q000469:parasitology* / Q000473:pathology; D011239:Prednisolone / Q000008:administration & dosage; D011507:Proteinuria / Q000209:etiology; D018805:Sepsis / Q000469:parasitology; D017171:Strongyloides stercoralis / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D016896:Treatment Outcome
D000977:Antiparasitic Agents; D005938:Glucocorticoids; D007559:Ivermectin; D011239:Prednisolone