Strongyloides stercoralis colitis in a patient positive for human T-cell leukaemia virus with rheumatoid arthritis during an anti-rheumatic therapy: a case report.
An elderly woman with rheumatoid arthritis (RA) presented with a chief complaint of abdominal pain and diarrhoea while undergoing treatment with low-dose corticosteroids and abatacept. Endoscopic and histopathological findings revealed manifestations of ulcerative colitis (UC). An intermediate dose of corticosteroids and 5-aminosalicylic acid were administered. Abatacept was discontinued; the anti-TNF biologic, golimumab, was administered for treatment of both RA and UC. However, colitis worsened in response to this therapeutic regimen. Colonoscopy revealed severe mucosal lesions; larvae were detected in samples taken from multiple shallow mucosal ulcers. The patient was diagnosed with Strongyloides stercoralis colitis based on the results of an anti-parasite antibody test and examination of the larval DNA. Furthermore, serology revealed a positive test for antibodies against human T-cell leukaemia virus type 1 (HTLV-1). Immunosuppressive treatment was terminated; ivermectin was administered, which resulted in improvements in colitis symptoms within a few weeks. There are several published reports describing S. stercoralis colitis as a lethal mimic of UC. Corticosteroid and anti-TNF therapies have been reported as among the major risk factors associated with strongyloidiasis in patients with HTLV-1 infection. Therefore, HTLV-1 and Strongyloides infections may be considered in cases of new-onset gastrointestinal symptoms during immunosuppressive therapy, particularly in HTLV-1-endemic regions.
['Hashiba|Yayoi|Y|', 'Umekita|Kunihiko|K|', 'Minami|Hiroyuki|H|', 'Kawano|Atsuko|A|', 'Nagayasu|Eiji|E|', 'Maruyama|Haruhiko|H|', 'Hidaka|Toshihiko|T|', 'Okayama|Akihiko|A|']
D000368:Aged D000818:Animals D000977:Antiparasitic Agents D001172:Arthritis, Rheumatoid D003093:Colitis, Ulcerative D005260:Female D015490:HTLV-I Infections D015368:Human T-lymphotropic virus 1 D006801:Humans D007166:Immunosuppressive Agents D007559:Ivermectin D017171:Strongyloides stercoralis D013322:Strongyloidiasis D000079424:Tumor Necrosis Factor Inhibitors
rheumatoid arthritis biologics human T-cell leukaemia virus type 1 Strongyloidiasis parasite infection