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Am. J. Trop. Med. Hyg., 66(5), 2002, pp. 572–574 Copyright © 2002 by The American Society of Tropical Medicine and Hygiene

JAVIER BAQUERA-HEREDIA, ALEJANDRO CRUZ-REYES, ADRIAN FLORES-GAXIOLA, GUILLERMO LÓPEZ-PULIDO, ELIGIO DÍAZ-SIMENTAL, AND LEONOR VALDERRAMA-VALENZUELA Laboratorio de Patología Quirúrgica, Centro Médico AmericanBritish Cowdray Institución de Asistencia Privada, México D.F., México; Instituto de Biología, Universidad Nacional Autónoma de México, México D.F., México; Servicio de Infectología y Servico de Oftalmología, Hospital General de Culiacán, Culiacán, Sinaloa, México; Servicio de Oftalmología, Instituto Mexicano del Seguro Social, Hospital Regional de Especialidades No. 1, Culiacán, Sinaloa, Mexico;Laboratorio de Anatomía Patológica, Hospital ´ Pediátrico de Sinaloa, Culiacán, Sinaloa, México

Abstract. A 42-year-old woman from Culiacan in the Sinaloa State of Mexico presented with a four-year history of migratory, pruritic, painful swellings of the face. Palpebral edema with conjunctival erythema developed when lesions developed near the eye. Routine eye examination showed a mobile worm in theanterior chamber. Following surgical removal, the parasite was identified by light and electron microscopy as an advanced third-stage larva of Gnathostoma sp. This prevalence of this helminthiasis may be increasing in areas where eating freshwater raw fish (“cebiche”) is customary. INTRODUCTION Cutaneous larva migrans syndrome due to advanced thirdstage larva (AL3) of Gnathostoma spp. is anemerging public health problem in Mexico, particularly in the states of Sinaloa, Oaxaca, Veracruz, Tamaulipas, Guerrero, and Nayarit.1–3 The custom of eating raw freshwater fish in the form of “cebiche” (traditional dish), “callos” (tiny pieces of raw fillet), and sushi is common in these areas. The first two cases in Mexico were reported in 1970,2 and many have been subsequently reported.4,5 Asidefrom the annoying symptoms of pruritus and pain, gnathostomiasis may be cause serious morbidity and even mortality if the parasite invades the central nervous system, where it leads to eosinophilic myelencephalitis and subarachnoid hemorrhage. Another serious complication is ocular involvement, which can cause blindness.6 We report here a case of ocular gnathostomiaisis successfully treated bysurgical excision of the larva. CASE REPORT A 42-year-old woman presented to an ophthalmologist with a four-year history of migratory and pruritic swellings that occasionally involved her face. Palpebral edema and pain in the conjunctiva developed when the lesions were near her eye. Such episodes usually lasted for 7–10 days and recurred once a year. A recent episode persisted for 15 days and wasassociated with palpebral hemorrhage, conjunctival erythema, and pain upon movement of the eye. The initial diagnosis was uveitis, which was treated with pyridoxine. Slit lamp examination disclosed a worm at the inferonasal quadrant of the margin of the iris. A bulbous dilatation was noted at the free end of the parasite. Although the patient was to be treated with laser photocoagulation, this was notdone and surgical excision was performed. The parasite had migrated to the posterior chamber of the eye. The surgeon injected sodium hyaluronate through a small keratotomy and the parasite spontaneously returned to the anterior chamber, where it freely floated. The diaphragm of the iris was closed with pilocarpine to prevent further migration. The larva was easily removed with a small forceps andplaced immediately in normal saline solution. The results of laboratory examination of the patient were unremarkable, except for low-grade blood eosinophilia (6%). The patient was discharged and not given anti-parasitic drugs. Results of follow-up slit lamp examination and visual function tests were normal. She has remained without symptoms for three years. THE PARASITE Examination of a wet mount...
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