Case Report Hypereosinophilia and Abdominopulmonary Gnathostomiasis

A 16-year-old Thai male presented with sudden onset severe epigastric and right upper quadrant pain, fever (39oC), chills and malaise. He gave no history of underlying disease, migratory swelling or urticarial skin rash. He had a history of frequently eating raw pork. Physical examination revealed a soft abdomen with markedly tender hepatomegaly. His blood count showed extreme leukocytosis with hypereosinophilia. After admission he developed a non-productive cough with left sided chest pain, a chest x-ray showed a left pleural effusion. Serological findings were positive for Gnathostoma larval antigen but not Fasciola antigen. The patient recovered completely after albendazole treatment. His clinical presentation is compatible with abdominopulmonary hypereosinophilic syndrome or visceral larva gnathostomiasis. The presented case is interesting not only for physicians who work in endemic areas of gnathostomiasis but also for clinicians who work in travel medicine clinics in developed countries, to consider abdominopulmonary gnathostomiasis when patients present with the signs and symptoms of visceral larva migrans. worms. Cutaneous migratory swelling is the most common presentation, while the most severe form is gnathostomiasis in infection of the central nervous system (Boongird et al, 1977; Daengsvang, 1980; Punyagupta et al, 1990). The disease is endemic in Asian countries, including Thailand. Outbreaks of gnathostomiasis have been reported in Mexico (DÌaz Camacho et al, 2003), and the disease is now considered an emerging imported helminthiasis (Moore et al, 2003; Ligon, 2005). In the past, definitive diagnosis of the disease relied on finding the worm in the tissues or recovery of the worm when it exits the body (Daengsvang, 1980; Sirikulchayanonta and Viriyavejakul, 2001) or after drug treatment (Suntharasamai et al, 1992; Kraivichian et al, 2004). With the advent of serological diagnosis, many more clinical cases can now be INTRODUCTION Human gnathostomiasis is caused by a nematode of the genus Gnathostoma (Miyazaki, 1960; Daengsvang, 1980). Several species affect man, but G. spinigerum is the predominant species in Thailand. Man is an accidental host who often acquires the infection by eating raw or inadequately cooked meat containing third-stage larvae of the worm. In humans, the larva penetrates the gastrointestinal tract and migrates to various organs causing tissue damage. Signs and symptoms depend on the site of migrating ABDOMINOPULMONARY GNATHOSTOMIASIS Vol 39 No. 5 September 2008 805 confirmed (Maleewong et al, 1988; Tapchaisri et al, 1991). In this paper we present a clinical case of visceral larval gnathostomiasis confirmed by serological examination.