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    Right arm of the patient showing non-pitting swelling.

  • View in gallery

    Left leg of the patient showing non-pitting swelling and subcutaneous hemorrhage.

  • 1.

    Rusnak JM, Lucey DR, 1993. Clinical gnathostomiasis: case report and review of the English-language literature. Clin Infect Dis 16: 33.

  • 2.

    Herman JS, Chiodini PL, 2009. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev 22: 484492.

  • 3.

    Kanyarat K, Surang N, Prasert S, Wanpen C, Sutin Y, 2004. Treatment of cutaneous gnathostomiasis with ivermectin. Am J Trop Med Hyg 71: 623628.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A 41-Year-Old Woman with Migratory Panniculitis

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  • Infectious Diseases Department, Instituto Nacional de Rehabilitación, Mexico City, Mexico

A 41-year-old woman had two months of intermittent migratory swellings in the trunk, face, and limbs associated with erythema, pruritus, and pain. Laboratory analysis showed moderate eosinophilia. The triad of eosinophilia, migratory lesions (nodular panniculitis), and raw fish consumption was highly suggestive of cutaneous gnathostomiasis. She was successfully treated with albendazole (400 mg twice a day for 21 days) and showed complete and permanent resolution of the lesions.

A 41-year-old woman had two months of intermittent migratory swellings in the trunk, face, and limbs associated with erythema, pruritus, and pain. The skin lesions were recurrent, typically lasting 1–2 weeks before spontaneous resolution. She denied fever, chills, or other clinical signs. She reported regular consumption of undercooked raw fish and shellfish. Physical examination showed palpable, non-pitting swelling in the right arm (Figure 1) and left leg, this leg showed subcutaneous hemorrhage (Figure 2). Laboratory analysis showed moderate eosinophilia (960 cells/mm3). The triad of eosinophilia, migratory lesions (nodular panniculitis), and raw fish consumption was highly suggestive of cutaneous gnathostomiasis.

Figure 1.
Figure 1.

Right arm of the patient showing non-pitting swelling.

Citation: The American Society of Tropical Medicine and Hygiene 90, 5; 10.4269/ajtmh.13-0318

Figure 2.
Figure 2.

Left leg of the patient showing non-pitting swelling and subcutaneous hemorrhage.

Citation: The American Society of Tropical Medicine and Hygiene 90, 5; 10.4269/ajtmh.13-0318

Two weeks before arrival, she received a single dose of ivermectin (200 μg/kg) and showed no resolution. She was given albendazole (400 mg twice a day for 21 days) and showed complete and permanent resolution of the lesions. Gnathostomiasis is a food-borne zoonosis secondary to ingestion of raw fish or shellfish contaminated with larvae of Gnathostoma spp. It is observed mainly in tropical regions, and increasingly in Latin America particularly Mexico.1,2 Previous studies showed slightly more relapses in patients treated with ivermectin.3 Few clinicians outside of disease-endemic areas are familiar with gnathostomiasis. Therefore, diagnosis is often missed, which can lead to potentially serious consequences.2

  • 1.

    Rusnak JM, Lucey DR, 1993. Clinical gnathostomiasis: case report and review of the English-language literature. Clin Infect Dis 16: 33.

  • 2.

    Herman JS, Chiodini PL, 2009. Gnathostomiasis, another emerging imported disease. Clin Microbiol Rev 22: 484492.

  • 3.

    Kanyarat K, Surang N, Prasert S, Wanpen C, Sutin Y, 2004. Treatment of cutaneous gnathostomiasis with ivermectin. Am J Trop Med Hyg 71: 623628.

Author Notes

* Address correspondence to Edgar S. Vanegas, Infectious Diseases Department, Instituto Nacional de Rehabilitación, Calz, Mexico-Xochimilco No. 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389, Mexico City DF, Mexico. E-mail: samuel_vanegas@yahoo.com

Authors' addresses: Edgar S. Vanegas, Rafael Franco Cendejas, and Arturo Mondragón, Infectious Diseases Department, Instituto Nacional de Rehabilitación, Calz. Mexico-Xochimilco No. 289, Col. Arenal de Guadalupe, Del. Tlalpan, 14389 Mexico City DF, Mexico, E-mails: samuel_vanegas@yahoo.com, raffcend@yahoo.com, and arteguiluz@yahoo.com.mx.

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