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Images in Clinical Tropical Medicine

Spinal Epidural Hematoma and Gnathostomiasis

Verajit Chotmongkol Department of Medicine and Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand

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Amnat Kitkhuandee Department of Medicine and Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand

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Kittisak Sawanyawisuth Department of Medicine and Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand

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DOI:
https://doi.org/10.4269/ajtmh.14-0579
Volume/Issue:
Volume 92: Issue 4
Page(s):
677
Open access
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Typically, spinal gnathostomiasis is presented as radiculomyelitis.1 Here, we report a spinal epidural hematoma caused by Gnathostoma spinigerum. A 28-year-old man presented with acute chest pain for 1 hour. The pain was very severe, with dull aching on his left chest and toward his back. At the hospital, he developed paraplegia and sensory loss up to the T4 level. Physical examination revealed loss of proprioceptive sensation in both feet with loose rectal sphincter tone. Laboratory tests showed no peripheral eosinophilia, normal echocardiogram, and normal computed tomography (CT) angiogram of the aorta. Magnetic resonance imaging (MRI) of thoracic spine showed an isointensity lesion on the T1 weighted image (Figure 1) and mixed hyper- and hypointensity on the T2 weighted image at the left posterior aspect of the thoracic thecal sac (Figure 2). The lesion compressed to the thoracic spinal cord. The operative finding was epidural hematoma at the T4ā€“T6 level. Blood serological study for gnathostomiasis using the immunoblotting technique was positive for the 24-kDa antigenic band.2 This diagnostic band has a sensitivity of 91.7% and a specificity of 100% compared with healthy control subjects.2 The patient received supportive treatment, and the weakness was gradually returned to normal within a few months.

Figure 1.
Figure 1.

MRI of thoracic spine showed an isointensity lesion on the T1 weighted image at the posterior aspect of the thoracic thecal sac.

Citation: The American Society of Tropical Medicine and Hygiene 92, 4; 10.4269/ajtmh.14-0579

Figure 2.
Figure 2.

MRI of thoracic spine showed a mixed hyper- and hypo-intensity lesion on the T2 weighted image at the left posterior aspect of the thoracic thecal sac. The lesion compressed the thoracic spinal cord.

Citation: The American Society of Tropical Medicine and Hygiene 92, 4; 10.4269/ajtmh.14-0579

  • 1.ā†‘

    Katchanov J, Sawanyawisuth K, Chotmongkoi V, Nawa Y, 2011. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis 17: 1174ā€“1180.

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  • 2.ā†‘

    Intapan PM, Khotsri P, Kanpittaya J, Chotmongkol V, Sawanyawisuth K, Maleewong W, 2010. Immunoblot diagnostic test for neurognathostomiasis. Am J Trop Med Hyg 83: 927ā€“929.

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Author Notes

* Address correspondence to Kittisak Sawanyawisuth, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. E-mail: kittisak@kku.ac.th

Authors' addresses: Verajit Chotmongkol and Amnat Kitkhuandee, Department of Medicine and Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, E-mails: vercho@kku.ac.th and amnat711@yahoo.com. Kittisak Sawanyawisuth, Department of Medicine and Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, and Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen, Thailand, E-mail: kittisak@kku.ac.th.

Copyright:
Ā© The American Society of Tropical Medicine and Hygiene 2015
Received:
15 Sep 2014
|
Accepted:
22 Oct 2014
|
Published Online:
01 Apr 2015
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • Figure 1.
    View in gallery
    Figure 1.

    MRI of thoracic spine showed an isointensity lesion on the T1 weighted image at the posterior aspect of the thoracic thecal sac.

  • Figure 2.
    View in gallery
    Figure 2.

    MRI of thoracic spine showed a mixed hyper- and hypo-intensity lesion on the T2 weighted image at the left posterior aspect of the thoracic thecal sac. The lesion compressed the thoracic spinal cord.

Figure 1.

MRI of thoracic spine showed an isointensity lesion on the T1 weighted image at the posterior aspect of the thoracic thecal sac.
Figure 2.

MRI of thoracic spine showed a mixed hyper- and hypo-intensity lesion on the T2 weighted image at the left posterior aspect of the thoracic thecal sac. The lesion compressed the thoracic spinal cord.
  • 1.

    Katchanov J, Sawanyawisuth K, Chotmongkoi V, Nawa Y, 2011. Neurognathostomiasis, a neglected parasitosis of the central nervous system. Emerg Infect Dis 17: 1174ā€“1180.

    • Search Google Scholar
    • Export Citation
  • 2.

    Intapan PM, Khotsri P, Kanpittaya J, Chotmongkol V, Sawanyawisuth K, Maleewong W, 2010. Immunoblot diagnostic test for neurognathostomiasis. Am J Trop Med Hyg 83: 927ā€“929.

    • Search Google Scholar
    • Export Citation
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