A 37-Year-Old Man with Multiple Symptoms Following a Trip to Japan

The Resolution

Differential Diagnosis

• Cutaneous larva migrans
• Gnathostomiasis
• Loiasis
• Strongyloidiasis

Diagnosis

This patient was diagnosed with gnathostomiasis, a helminth infection contracted after ingesting raw fish, frog, chicken, or pork infected with Gnathostoma spinigerum and other minor Gnathostoma spp.

 

Learnings

• Gnathostomiasis is endemic to parts of Asia and South/Central America
• Symptoms are thought to relate to the movement of the parasite through the body
  • Constitutional symptoms may occur when it moves through the wall of the stomach (2 days to 2 weeks after ingestion), and skin manifestations when it moves under the skin (3 to 4 weeks after ingestion)
• Cutaneous manifestations are not unlike loiasis, in which the patient complains of migratory cutaneous and subcutaneous swellings which may be amorphous or resemble cutaneous larva migrans (serpiginous)
• Patients may complain of pruritus, arthralgias and myalgias, fever, nausea, and abdominal pain. However, larvae can migrate through any organ and, therefore, nearly any physical symptom is possible (eg, right-upper-quadrant pain and transaminitis may occur as the larvae migrate through the liver)

 

Pearls for Urgent Care Management and Considerations for Transfer

• Albendazoleand ivermectin have been shown to be curative for cutaneous symptoms
• Recurrence requiring retreatment is not uncommon

 

Acknowledgment: Images and presentation courtesy of VisualDx.