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Ben-Horin S, Barshack I, Chowers Y, Mouallem M. Flare-up of ulcerative colitis after systemic corticosteroids: A strong case for Strongyloides. World J Gastroenterol 2008; 14(27): 4413-4415 [PMID: 18666337 DOI: 10.3748/wjg.14.4413]
World J Gastroenterol. Jul 21, 2008; 14(27): 4413-4415 Published online Jul 21, 2008. doi: 10.3748/wjg.14.4413
Flare-up of ulcerative colitis after systemic corticosteroids: A strong case for Strongyloides
Shomron Ben-Horin, Iris Barshack, Yehuda Chowers, Meir Mouallem
Shomron Ben-Horin, Yehuda Chowers, Department of Gastroenterology, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer 52621, Israel
Iris Barshack, Pathology Institute, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer 52621, Israel
Meir Mouallem, Department of Medicine E, Sheba Medical Center, and Sackler School of Medicine, Tel-Aviv University, Tel-Hashomer 52621, Israel
Author contributions: Ben-Horin S extracted the clinical data and wrote the manuscript; Moullaem M and Chowers Y were the treating physicians and participated in drafting and writing the manuscript; Barshack I prepared and interpreted the histological specimens.
Correspondence to: Dr. Shomron Ben-Horin, Gastroen-terology Department, Sheba Medical Center, Tel-Hashomer 52621, Israel. sben-horin@013.net.il
Telephone: +972-3-5302694
Fax: +972-3-5303160
Received: April 26, 2008 Revised: June 2, 2008 Accepted: June 9, 2008 Published online: July 21, 2008
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.
