Although exacerbation of UC usually poses little diagnostic dilemma, physicians should remain cognizant to the possibility of an alternative cause for patient symptoms.
An article to be published on July 21, 2008 of the World Journal of Gastroenterology addresses this report. The research team led by Prof. Ben-Horin from the Gastroenterology department of Sheba Medical Center in Israel described a 54-year-old patient with long standing ulcerative colitis who experienced fever, diarrhea and abdominal pain 2 week after receiving corticosteroids as a treatment for severe cluster headaches.
After empiric antibiotics proved ineffective, the patient underwent upper and lower endoscopic studies. Biopsies obtained from the inflamed duodenal mucosa showed evidence of infection with the nematode Strongyloides stercoralis. This parasite is only found in certain tropic and sub-tropic areas of the world, but not in Israel. Thus, it was most likely acquired by the patient 20 years earlier, when he was residing in Brazil, and remained dormant until steroid treatment has weakened the patient immune resistance to this infection.
The patient made complete recovery following appropriate treatment with anti-parasitic drug. The researchers note that this patient's case underscores the need to exclude even rare parasitic infections that may mimic a flare-up of ulcerative colitis.
This is especially important before increasing immuno-suppression, since inhibition of the immune system by these drugs facilitates further dissemination of Strongyloides parasites and can result in a fatal infection.