DermatopathologyCutaneous gnathostomiasis: Report of 6 cases with emphasis on histopathological demonstration of the larva
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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2021, Actas Dermo-SifiliograficasA practical approach to the clinico-pathological diagnosis of panniculitis
2021, Diagnostic HistopathologyCitation Excerpt :To find the larva is very uncommon but good hints for the diagnosis are a clinical history of itchy and migrating plaques and nodules in a patient who ate raw fish and presents a peripheral eosinophilia correlating with a dense eosinophilic dermal or subcutaneous infiltrate. Flame figures, eosinophilic vasculitis, spongiosis or dermal edema can be also found as well as necrotic fat tissue.27 Sclerosing panniculitis or lipodermatosclerosis: This frequent panniculitis appears as a complication of chronic venous insufficiency and it is clinically characterized by a marked reduction of the diameter of the distal lower leg with an extensive sclerosis and atrophy of the subcutaneous fat.
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2018, Anais Brasileiros de DermatologiaCitation Excerpt :A very interesting presentation is the so-called pseudo-furuncular type. As described by multiple authors, either spontaneously or, more commonly, a few days after therapy, the clinical lesion evolves from a large nodular or ill-defined infiltrated area to a tiny papule or even a pustule (Figure 5).1,18,19 This phenomenon represents the upward migration of the parasite towards the surface of the skin.
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2017, Travel Medicine and Infectious DiseaseCitation Excerpt :A definitive diagnosis can be made by observing larvae in skin, urine, sputum, cerebrospinal fluid (CSF), and ocular specimens [4,7]. In cutaneous gnathostomiasis, observation of larvae in biopsy samples provides a definitive diagnosis [45,46], and the species responsible can be identified by microscopic analysis of sections of larvae [6,47]. However, the yield of biopsies is often 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.