PMID- 32615937
OWN - NLM
STAT- MEDLINE
DCOM- 20200821
LR  - 20211204
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 20
IP  - 1
DP  - 2020 Jul 2
TI  - Fatal outcome in a patient under immunosuppressant therapy infected with human 
      T-lymphotropic virus type 1 (HTLV-1), cytomegalovirus (CMV) and Strongyloides 
      stercoralis: a case report.
PG  - 470
LID - 10.1186/s12879-020-05195-0 [doi]
LID - 470
AB  - BACKGROUND: Strongyloidiasis is a gastrointestinal parasitic infection caused by 
      percutaneous infection with Strongyloides stercoralis. Digestive symptoms such as 
      diarrhea and abdominal pain are the main manifestation, but serious infections 
      such as septicemia, purulent meningitis, and bacterial pneumonia may occur in 
      individuals harboring human T-lymphotropic virus type 1 (HTLV-1) or who are 
      immunocompromised. Although coinfection with Strongyloides stercoralis and HTLV-1 
      can lead to chronic strongyloidiasis and a disseminated form of the disease, 
      there is a high rate of response to the anthelmintic ivermectin. CASE 
      PRESENTATION: We report a case of strongyloidiasis infection syndrome that was 
      difficult to differentiate from immune reconstitution inflammatory syndrome 
      (IRIS) for various reasons. The patient had been treated with the corticosteroids 
      tacrolimus (Tac) and mycophenolate mofetil (MMF) for systemic lupus erythematosus 
      (SLE) with lupus nephritis and pancytopenia. When the steroid was reduced, she 
      developed cytomegalovirus (CMV) enteritis, and her respiratory status rapidly 
      deteriorated immediately after the withdrawal of Tac and MMF. It was difficult to 
      distinguish immune reconstitution inflammatory syndrome from strongyloidiasis 
      infection syndrome because stool cultures were negative and eosinophils were not 
      increased. Bronchoscopy revealed viable Strongyloides, leading to a diagnosis of 
      strongyloidiasis infection syndrome, but the patient died despite treatment. 
      CONCLUSIONS: Both corticosteroid therapy and HTLV-1 infection can be associated 
      with a decrease of eosinophils, despite the presence of parasitic infection. In 
      conclusion, even if multiple culture tests are negative, the risk of parasitic 
      infection should be assessed in patients receiving immunosuppressants and 
      steroids even in non-endemic areas.
FAU - Ashida, Chisato
AU  - Ashida C
AUID- ORCID: 0000-0003-3137-0138
AD  - Department of Hematology and Rheumatology, Kindai University School of Medicine, 
      377-2 Oonohigashi, Osaka-Sayama, Osaka, 589-0014, Japan. 
      c-ashida@med.kindai.ac.jp.
FAU - Kinoshita, Koji
AU  - Kinoshita K
AD  - Department of Hematology and Rheumatology, Kindai University School of Medicine, 
      377-2 Oonohigashi, Osaka-Sayama, Osaka, 589-0014, Japan.
FAU - Nozaki, Yuji
AU  - Nozaki Y
AD  - Department of Hematology and Rheumatology, Kindai University School of Medicine, 
      377-2 Oonohigashi, Osaka-Sayama, Osaka, 589-0014, Japan.
FAU - Funauchi, Masanori
AU  - Funauchi M
AD  - Department of Hematology and Rheumatology, Kindai University School of Medicine, 
      377-2 Oonohigashi, Osaka-Sayama, Osaka, 589-0014, Japan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20200702
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
RN  - 0 (Anthelmintics)
RN  - 0 (Antiviral Agents)
RN  - 0 (Immunosuppressive Agents)
RN  - 70288-86-7 (Ivermectin)
RN  - P9G3CKZ4P5 (Ganciclovir)
SB  - IM
MH  - Aged
MH  - Animals
MH  - Anthelmintics/therapeutic use
MH  - Antiviral Agents/therapeutic use
MH  - Coinfection/drug therapy
MH  - Cytomegalovirus/*immunology/isolation & purification
MH  - Cytomegalovirus Infections/*complications/diagnosis/drug therapy/virology
MH  - Fatal Outcome
MH  - Female
MH  - Ganciclovir/therapeutic use
MH  - HTLV-I Infections/*complications/diagnosis/drug therapy/virology
MH  - Human T-lymphotropic virus 1/*isolation & purification
MH  - Humans
MH  - Immunocompromised Host
MH  - Immunosuppression Therapy/*adverse effects
MH  - Immunosuppressive Agents/adverse effects/*therapeutic use
MH  - Ivermectin/therapeutic use
MH  - Lupus Erythematosus, Systemic/*complications/*drug therapy
MH  - Strongyloides stercoralis/*isolation & purification
MH  - Strongyloidiasis/*complications/diagnosis/drug therapy/parasitology
MH  - Syndrome
PMC - PMC7331000
OTO - NOTNLM
OT  - Case report
OT  - Cytomegalovirus
OT  - Immune reconstitution inflammatory syndrome
OT  - Strongyloidiasis
COIS- Not applicable.
EDAT- 2020/07/04 06:00
MHDA- 2020/08/22 06:00
PMCR- 2020/07/02
CRDT- 2020/07/04 06:00
PHST- 2020/03/17 00:00 [received]
PHST- 2020/06/24 00:00 [accepted]
PHST- 2020/07/04 06:00 [entrez]
PHST- 2020/07/04 06:00 [pubmed]
PHST- 2020/08/22 06:00 [medline]
PHST- 2020/07/02 00:00 [pmc-release]
AID - 10.1186/s12879-020-05195-0 [pii]
AID - 5195 [pii]
AID - 10.1186/s12879-020-05195-0 [doi]
PST - epublish
SO  - BMC Infect Dis. 2020 Jul 2;20(1):470. doi: 10.1186/s12879-020-05195-0.