Abstract. We report a rare case of a patient with ileus due to Strongyloides infection that occurred four times within a six-month period. The ileus was improved by treatment with ivermectin and there has not been a recurrence of the symptoms within the last two years.Strongyloides stercoralis is an intestinal nematode that is widely distributed in the soil throughout tropical and subtropical areas. Patients infected with this parasite may be asymptomatic or may develop a wide variety of complaints. The common symptoms are abdominal pain, weight loss, diarrhea, nausea, and vomiting. In immunocompromised patients, this parasite may cause a superinfection or a disseminated infection. [1][2][3][4][5] In this paper we report a rare case of a patient who contracted ileus and whose symptoms recurred four times in a six-month period. CASE REPORTA 70-year-old man was admitted to Sawara Hospital with constipation, abdominal pain, and vomiting. He had not lived in or visited an area endemic for S. stercoralis. In December 1994, he visited a local hospital with obstipation, but a barium enema did not show any abnormalities. On February 18, 1995, he was hospitalized at a local hospital due to nausea, vomiting, and abdominal pain. Ileus was diagnosed and treated conservatively with bowel rest and intravenous fluids. His condition soon improved and he was discharged on February 25; however, the same complaints reappeared and he was referred to our hospital on March 5th. He was treated with bowel rest and intravenous fluids for paralytic ileus, the symptoms disappeared, and he was discharged. On April 3, 1995, he was hospitalized once again at our hospital, and it was at this time that ileus reappeared for the fourth time. The patient was then readmitted on May 16, 1995.The patient was 163 cm tall and weighed 53.5 kg. The head and neck were normal. No lymphadenopathy was found. The lungs were clear and the heart was normal. The abdomen was flat and bowel sounds were present, and there was diffuse abdominal tenderness, without guarding or rebound tenderness. The liver and spleen were not palpated. No peripheral edema was noted.Stools tested for occult blood were negative. The hemoglobin level was 11.3 mg/dL, the white blood cell count was 9,200/l, with 71% neutrophils, 1% bands, 4% eosinophils, 17% lymphocytes, and 5% monocytes, and the platelet count was 233,000/l. The erythrocyte sedimentation rate was 50 m/hr. The C-reactive protein level was 0.1 mg/dL and the human T cell lymphotropic virus type-1 (HTLV-1) antibody titer was 512. Results of other studies, including blood chemistries, were all within normal limits. An abdominal radiograph demonstrated a marked air fluid level in the intestine (Figure 1) and a small bowel series showed atrophy and loss of intestinal fold and dilatation of the viscera. Gastroduodenoscopy showed coarse mucosa and loss of folds in the duodenum. A duodenum biopsy revealed Strongyloides larvae in the mucosa ( Figure 2). A microscopic examination of a stool sample was then performed and it demonst...

A case of chronic meningitis caused by the achloric alga Prototheca wickerhamii is described, which has persisted for more than 6 years despite treatment with various antifungal agents. For the last year no treatment has been given, but the patient has no complaints.

We reported a rare case of Plasmodium vivax malaria who showed findings of disseminated intravascular coagulation (DIC). A 50-year-old Japanese male was sent to our hospital with the diagnosis of Plasmodium vivax malaria on the 26th of April, 1990. He had stayed in the Solomon Islands from Oct. 1987 to Dec. 1989, and had febrile episodes during his stay in the island. On April 18, 1990, he complained of a high fever with chills, and showed the same episodes on the 20th, 22th and was diagnosed as malaria. He was treated successfully with the sulfadoxine 500 mg and pyrimethamine 25mg (Fansidar), following the normal temperature on the 4th day and disappearance of malarial parasites in the peripheral blood smear on the 6th day. Interestingly, he had thrombocytopenia and a high titer serum level of fibrin degradation product (FDP) supporting the questionable diagnosis of DIC. Even on the 12th day after improved thrombocytopenia by treatment with Gabexate (FOY), the serum level of FDP, D-dimer and thrombin-nati-thrombin (TAT)III complex still remained at high titer levels. One month later he was readmitted for a relapse of Plasmodium vivax malaria, when he showed thrombocytopenia but the serum level of FDP, D-dimer, TAT III complex and PM.alpha 2 PI complex were normal levels. We concluded that the thrombocytopenia and the high titer of FDP at his first admission was a manifestation of DIC.

Since it is very rare that cardiac tamponade due to myocardial rupture caused by infective endocarditis, occurs we are reporting this case. A 62 year old man, who had underlying diseases of pneumoconiosis and hypertensive heart disease, visited Chikuho Rosai Hospital complaining of chest oppression and general fatigue on Feb. 7, 1987. He was diagnosed as having ischemic heart disease by electrocardiogram. Two days later, he suddenly had chills and a fever, and the laboratory data showed leukocytosis and a positive C-reactive protein (CRP). The echo cardiogram showed mitral regurgitation (MR) and aortic regurgitation (AR), but neither vegetation nor pericardial effusion was observed. On Feb. 16, he was admitted with shock, and he died the next day. The blood cultures grew gram-positive cocci, respectively. From the clinical symptoms, chest roentgenogram and electrocardiogram, we suspected a cardiac tamponade. On autopsy findings, though coronary arteries were intact, the aortic valves had severe valvular adhesions, calcifications and hypertrophies. The rupture hole was observed in the left ventricles, which was just under the aortic valve through the pericardiac space. It seemed that he died of a cardiac tamponade due to the outflow of blood from this hole. On histopathologic findings of the cardiac wall, gram-positive cocci and many of neutrophils were observed.

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