Asunto(s)
Filariasis/complicaciones , Nefrosis Lipoidea/complicaciones , Nefrosis Lipoidea/parasitología , Síndrome Nefrótico/diagnóstico , Síndrome Nefrótico/parasitología , Animales , Biopsia , Dietilcarbamazina/uso terapéutico , Filariasis/tratamiento farmacológico , Filaricidas/uso terapéutico , Filarioidea/aislamiento & purificación , Humanos , Riñón/parasitología , Riñón/patología , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Strongyloidiasis, a chronic infection caused by the intestinal parasite Strongyloides stercoralis, is prevalent in the Nansei Islands of Japan. Here, we report our findings on a case of strongyloidiasis complicated with steroid-resistant minimal change nephrotic syndrome in a 69-year-old male resident of Fukuoka Prefecture who had lived in Yakushima, one of the Nansei Islands, until age 15. In October 2006, he developed proteinuria and edema, and was diagnosed with minimal change nephrotic syndrome on the basis of the renal biopsy findings. Following treatment with prednisolone, the level of proteinuria decreased to 0.29 g/day by day 35. However, 5 days later (day 40), the patient developed persistent watery diarrhea and vomiting, leading to dehydration and malnutrition. Pneumonia and bacterial meningitis subsequently developed (day 146); filarial (infectious-type) and rhabditiform (noninfectious-type) S. stercoralis larvae were detected for the first time in the patient's sputum, gastric juice, feces, and urine. Although treatment with ivermectin was started immediately and the parasitosis responded to the treatment, the patient died of sepsis. Consequently, although strongyloidiasis is a rare infection except in endemic regions, it is essential to consider the possibility of this disease and begin treatment early for patients who have lived in endemic areas and who complain of unexplained diarrhea during steroid-induced or other immunosuppression.
Asunto(s)
Nefrosis Lipoidea/parasitología , Strongyloides stercoralis/aislamiento & purificación , Estrongiloidiasis/parasitología , Anciano , Animales , Antiparasitarios/administración & dosificación , Biopsia , Diarrea/parasitología , Edema/etiología , Resultado Fatal , Glucocorticoides/administración & dosificación , Humanos , Ivermectina/administración & dosificación , Riñón/patología , Masculino , Nefrosis Lipoidea/tratamiento farmacológico , Nefrosis Lipoidea/patología , Prednisolona/administración & dosificación , Proteinuria/etiología , Sepsis/parasitología , Estrongiloidiasis/diagnóstico , Estrongiloidiasis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
We report a nephrotic syndrome patient with eosinophilia who developed ileus, epigastralgia and malabsorption due to strongyloidiasis which became symptomatic by steroid therapy. The patient was then treated with thiabendazole and recovered. A percutaneous renal biopsy revealed minimal change nephrotic syndrome. This renal injury may be brought on by severe infection of Strongyloides stercoralis. It is important to rule out strongyloidiasis prior to corticosteroid therapy to patients from eosinophilia endemic areas.
