{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:28:35Z","timestamp":1760189315757,"version":"3.44.0"},"reference-count":5,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>The treatment of ulcerative colitis is based on systemic corticosteroids, immunomodulators such as cyclosporine and azathioprine and TNF-\u03b1 antagonists. Patients undergoing such immunosuppressive treatment are more susceptible for infectious pathogens. Here, we report the case of a patient with a 13-year history of ulcerative colitis, treated initially with systemic corticosteroids in combination with immunomodulators, and subsequently with infliximab. The patient presented with severe watery diarrhoea, abdominal cramps, weight loss and low-grade fever. Stool examinations for cytomegalovirus, bacteria and parasites were negative. Following detection of numerous oocytes of <jats:italic>Isospora belli<\/jats:italic> (IB) in direct smear preparations of the diarrhoeic stool samples, the patient was successfully treated with trimethoprim-sulfamethoxazole (co-trimoxazole).<\/jats:p>","DOI":"10.1136\/bcr-2013-009837","type":"journal-article","created":{"date-parts":[[2013,5,25]],"date-time":"2013-05-25T02:03:44Z","timestamp":1369447424000},"page":"bcr2013009837","source":"Crossref","is-referenced-by-count":13,"title":["An unusual complication in ulcerative colitis during treatment with azathioprine and infliximab: <i>Isospora belli<\/i> as \u2018Casus belli\u2019"],"prefix":"10.1136","volume":"2013","author":[{"given":"Juergen","family":"Stein","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Krankenhaus Sachsenhausen, Frankfurt\/Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Egbert","family":"Tannich","sequence":"additional","affiliation":[{"name":"Department of Molecular Parasitology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Crohn-Colitis Centre Rhein-Main, Frankfurt\/Main, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,5,24]]},"reference":[{"key":"2025082801271203000_2013.may24_1.bcr2013009837.1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1056\/NEJM198607103150203","article-title":"Clinical manifestations and therapy of Isospora belli infection in patients with the acquired immunodeficiency syndrome","volume":"2013","author":"DeHovitz","year":"1986","journal-title":"N Engl J Med"},{"key":"2025082801271203000_2013.may24_1.bcr2013009837.2","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/j.transproceed.2007.02.080","article-title":"A rare diarrheic parasite in a liver transplant patient: Isospora belli","volume":"2013","author":"Atambay","year":"2007","journal-title":"Transplant Proc"},{"key":"2025082801271203000_2013.may24_1.bcr2013009837.3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1128\/CMR.10.1.19","article-title":"Biology of Isospora spp. from humans, nonhuman primates, and domestic animals","volume":"2013","author":"Lindsay","year":"1997","journal-title":"Clin Microbiol Rev"},{"key":"2025082801271203000_2013.may24_1.bcr2013009837.4","doi-asserted-by":"crossref","first-page":"304","DOI":"10.4269\/ajtmh.2002.67.304","article-title":"Comparison of autofluorescence and iodine staining for detection of Isospora belli in feces","volume":"2013","author":"Bialek","year":"2002","journal-title":"Am J Trop Med Hyg"},{"key":"2025082801271203000_2013.may24_1.bcr2013009837.5","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1038\/ncpgasthep0557","article-title":"Treatment options for the eradication of intestinal protozoa","volume":"2013","author":"Farthing","year":"2006","journal-title":"Nat Clin Pract Gastroenterol Hepatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2013-009837","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:27:18Z","timestamp":1756369638000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2013-009837"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,24]]},"references-count":5,"alternative-id":["10.1136\/bcr-2013-009837"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2013-009837","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2013,5,24]]}}}