Migrerende zwellingen uit Azië: gnathostomiasis

- Two patients suffered from intermittent subcutaneous swellings of the face. A 41-year-old man recalled a recent episode with severe thoracic pain and at that time pleurisy was documented. In this patient there was pronounced eosinophilia. The other was a 32-year-old woman. Both patients had traveled to southeast Asia. Antibodies against Gnathostoma spinigerum were detectable in both patients. The first patient was treated with albendazole 200 b.i.d. for three weeks, but because of recurrent facial swelling, he was treated again with albendazole at a higher dose: 400 b.i.d. for eight weeks, which the swellings did not recur. The second patient was not treated because the frequency of the swellings had already decreased spontaneously. Gnathostomiasis is an infection by the nematode G. spinigerum. The main route of human infection is by eating insufficiently not well-cooked fish or frog. The initial infection is often not recognised, but severe symptoms can occur. In humans, the larva of the nematode does not develop further but may wander through the subcutaneous tissues. Untreated, the infection usually runs a mild, self limiting course, but complications such as invasion of the central nervous system or of the eye have been described. Treatment with albendazole reduces recurrence of swellings.