Dermatopathology
Cutaneous gnathostomiasis: Report of 6 cases with emphasis on histopathological demonstration of the larva

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Background

Cutaneous gnathostomiasis is an emerging food-borne parasitic zoonosis. Histopathological demonstration of the larva on random biopsy specimen of erythematous plaques is infrequent because of its migrating nature.

Objective

We sought to determine whether medical treatment with albendazole or ivermectin increases the diagnostic yield of skin biopsy specimen.

Methods

A retrospective chart review was conducted in a private dermatology practice in Lima, Peru. Cases with a clinical diagnosis of nodular migratory panniculitis and pathological diagnosis of eosinophilic panniculitis or gnathostomiasis were reviewed. Only cases with definitive diagnosis confirmed by histopathology or parasite isolation were included in the study.

Results

A definitive diagnosis of gnathostomiasis was rendered in 6 of 55 reviewed cases. Histopathological or gross identification of the nematode’s larva was made obtaining a biopsy specimen of papules or pseudofuruncles that developed after oral antiparasitic treatment.

Limitations

This is a retrospective case series study and no serologic testing was available.

Conclusion

Biopsy of a papule or pseudofuruncle subsequent to oral treatment increases the likelihood of demonstrating the larva on skin biopsy specimen, which allows definitive diagnosis and may have therapeutic benefit.

Section snippets

Methods

This study was performed according to an institutional review board–approved protocol. A retrospective chart review was conducted in a private dermatology practice in Lima, Peru. Cases with a clinical diagnosis of nodular migratory panniculitis and pathological diagnosis of eosinophilic panniculitis or gnathostomiasis were reviewed. Only cases with definitive diagnosis confirmed by histopathology or parasite isolation were included in the study. Age, gender, mode of acquisition, treatment, time

Results

All, 55 patients were given the diagnosis of eosinophilic panniculitis compatible with gnathostomiasis based on clinical presentation, dietary history, and histologic findings. A definitive diagnosis of gnathostomiasis was rendered in 6 cases (11%). In 4 of these cases, the diagnosis was confirmed after identification of third-stage larvae on skin biopsy specimen. For the other 2 cases, the diagnosis was confirmed after positive identification of whole late-stage larva recovered from pustules.

Case 1

A 39-year-old man presented with a 1-month history of migratory, red, tender nodules that migrated on his face, from the center of the forehead to the right supraorbital region (Fig 1). The patient regularly ingested raw fish marinated in lime juice (ceviche). An initial 3-mm punch biopsy specimen from the center of his forehead was taken, which showed an interstitial inflammatory infiltrate rich in eosinophils. A presumptive diagnosis of gnathostomiasis was made and the patient was prescribed

Discussion

We present 6 cases of cutaneous gnathostomiasis with diagnostic confirmation by identification of the characteristic third-stage larva–either in biopsy specimen (4 cases) or by direct identification of the whole larva (2 cases)–from discrete papules or pustules that developed after initiation of treatment with oral antiparasitic agents. Although single case reports have documented the larva at initial presentation, random biopsy specimens from swollen erythematous areas are of extremely low

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A mentorship award from the American Society of Dermatopathology to Dr Laga supported this work.

Conflicts of interest: None declared.

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