Fulminant strongyloidiasis successfully treated by subcutaneous ivermectin: an autopsy case

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  • Takashima Nobuyoshi
    Department of Neurology, Miyazaki Prefectural Hospital of Nobeoka Department of Internal Medicine, School of Medicine, University of Miyazaki
  • Yazawa Shogo
    Department of Neurology, Miyazaki Prefectural Hospital of Nobeoka
  • Ishihara Akira
    Department of Anatomic Pathology, Miyazaki Prefectural Hospital of Nobeoka
  • Sugimoto Sei-ichiro
    Department of Neurology, Miyazakihigashi Hospital, National Hospital Organization
  • Shiomi Kazutaka
    Department of Internal Medicine, School of Medicine, University of Miyazaki
  • Hiromatsu Kenji
    Department of Microbiology and Immunology, School of Medicine, Fukuoka University
  • Nakazato Masamitsu
    Department of Internal Medicine, School of Medicine, University of Miyazaki

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Other Title
  • Ｉｖｅｒｍｅｃｔｉｎの皮下投与が奏効した重症播種性糞線虫症の１剖検例
  • 症例報告 Ivermectinの皮下投与が奏効した重症播種性糞線虫症の1剖検例
  • ショウレイ ホウコク Ivermectin ノ ヒカ トウヨ ガ ソウコウシタ ジュウショウ ハシュセイ フン センチュウショウ ノ 1 ボウケンレイ

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We report a 49-year-old man who was a human T-cell leukemia virus type 1 (HTLV-1) carrier, born in Okinawa prefecture where both strongyloidiasis and HTLV-1 are endemic. He presented with fever, headache and urinary retention. On the basis of CSF examination and MRI findings, his condition was diagnosed as myelitis. He received methylprednisolone pulse therapy. He was transferred to our hospital due to severe paralytic ileus. Strongyloides stercoralis (S. stercoralis) was found in the duodenal stained tissue of a biopsy specimen. Ivermectin applied both orally and through enema were ineffective because of severe ileus and intestinal bleeding. Nine mg (200μg/kg) of ivermectin solution was administered subcutaneously every other day for five days (total amount 45mg). The S. stercoralis burden in the stool decreased and paralytic ileus gradually resolved. Three weeks after the resolution of S. stercoralis infection, purulent meningitis developed and acute obstructive hydrocephalus appeared. The hydrocephalus improved by ventricular drainage. Approximately three months after drainage, he died of incidental aspiratory pneumonia. Autopsy showed neither eggs nor larvae of S. stercoralis in the organs. In this case, the fourth reported case in the world, subcutaneous ivermectin injection was dramatically effective. We should consider a diagnosis of strongyloidiasis for any patient from Okinawa prefecture who was an HTLV-1 carrier presenting with unknown origin ileus after treatment of steroid therapy.<br>

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