Takashima Nobuyoshi, Yazawa Shogo, Ishihara Akira, Sugimoto Sei-ichiro, Shiomi Kazutaka, Hiromatsu Kenji, Nakazato Masamitsu
Department of Neurology, Miyazaki Prefectural Hospital of Nobeoka.
Rinsho Shinkeigaku. 2008 Jan;48(1):30-5. doi: 10.5692/clinicalneurol.48.30.
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 (200 microg/kg) of ivermectin solution was administered subcutaneously every other day for five days (total amount 45 mg). 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.
我们报告了一名49岁的男性，他是1型人类T细胞白血病病毒（HTLV-1）携带者，出生于冲绳县，该地类圆线虫病和HTLV-1均为地方病。他出现发热、头痛和尿潴留。根据脑脊液检查和磁共振成像（MRI）结果，其病情被诊断为脊髓炎。他接受了甲泼尼龙冲击疗法。由于严重的麻痹性肠梗阻，他被转至我院。在活检标本的十二指肠染色组织中发现了粪类圆线虫。由于严重的肠梗阻和肠道出血，口服和灌肠给予伊维菌素均无效。每隔一天皮下注射9毫克（200微克/千克）伊维菌素溶液，共注射五天（总量45毫克）。粪便中粪类圆线虫的数量减少，麻痹性肠梗阻逐渐缓解。粪类圆线虫感染消退三周后，发生了化脓性脑膜炎并出现急性梗阻性脑积水。通过脑室引流，脑积水得到改善。引流约三个月后，他死于偶发的吸入性肺炎。尸检显示器官中既没有粪类圆线虫的虫卵也没有幼虫。在该病例（世界上第四例报告病例）中，皮下注射伊维菌素效果显著。对于任何来自冲绳县、为HTLV-1携带者且在接受类固醇治疗后出现不明原因肠梗阻的患者，我们都应考虑类圆线虫病的诊断。
