Cases reported "Colitis, Ulcerative"

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1/4. strongyloides stercoralis infestation in a patient with severe ulcerative colitis.

    Asymptomatic infestation with strongyloides stercoralis, common in the tropics, may result in potentially fatal hyperinfection during treatment with immunosuppressive drugs used to treat patients with severe ulcerative colitis (UC). Hence, importance of early recognition and treatment of this nematode in patients with UC before starting immunosuppressive drugs can not be overemphasized. We report a 23-yrs old man with UC who presented with acute severe attack. Since his UC did not respond to intravenous hydrocortisone over 6 days, oral cyclosporine was started on 7th day after repeating stool microscopy, which revealed larvae of strongyloides stercoralis. Duodenal aspirate also confirmed presence of multiple larvae. He responded to treatment for strongyloides stercoralis , continuation of hydrocortisone and cyclosporine. Importance of early diagnosis of infestation with strongyloides stercoralis while on treatment with immunosuppressive drugs for severe UC is emphasized. Difficulties in diagnosis and management of strongyloides stercoralis infestation in patients with UC are discussed.
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2/4. strongyloides stercoralis colitis: findings in four cases.

    The 4 cases of strongyloides stercoralis colitis presented show various radiological manifestations of colonic reaction. Mild involvement may be associated with minimal radiographic changes. Invasion of the bowel wall by the larvae results in ulceration and edema with loss of haustral markings; stricture may develop. barium-enema examinations can help in evaluating the nature and clinical progress of the disease.
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3/4. A case of systemic strongyloidiasis in an ex-coal miner with idiopathic colitis.

    An ex-coal miner was diagnosed with an idiopathic sigmoiditis compatible with colitis ulcerosa. He was treated with corticosteroids because of his deteriorating clinical condition, but his condition continued to worsen. He revealed to have a systemic strongyloides stercoralis hyperinfection and Strongyloides colitis. A short time after diagnosis he died from septic shock despite therapy with thiabendazole and antibiotics. S. stercoralis is an opportunistic infection that is not uncommon and has high mortality in hyperinfection. It is prevalent in (sub)tropical areas, and also in coal mines because of the specific microclimate. However, the parasite is difficult to detect because eosinophilia can appear normal in chronic infection. Several stool examinations, duodenal aspiration or biopsies are necessary for a high diagnostic sensitivity. Serological diagnosis is the most sensitive and specific but is not always available.
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4/4. Colonic strongyloides stercoralis infection masquerading as ulcerative colitis.

    strongyloides stercoralis is a nematode infection which predominantly involves the small bowel. Spillover infection to the colon does occur, but is uncommon and is usually associated with an immunocompromised host. Accurate diagnosis is essential and, as this case demonstrates, a long history does not preclude an infective aetiology.
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