A Case of Spontaneous Pneumothorax Complicating Gnathostomiasis

Case Report: The First Direct Evidence of Gnathostoma spinigerum Migration through Human Lung

“…23 Thoracentesis was performed in a case with pleural effusion, demonstrating exudative pleural fluid with abundant eosinophils. 10,23 In all previously reported cases, there was no direct evidence of pulmonary invasion except for indefinite chest symptoms and/or the expectoration of worms. In several cases from Thailand, the larval worm migrated to the upper respiratory tract or even to the pharynx; then, it was ultimately expectorated, and chest symptoms were resolved.…”

“…7,19,20 Therefore, a presumptive diagnosis is usually made based on the clinical manifestations of a migratory swelling and a history of consuming of freshwater fish or other intermediate or paratenic hosts in an endemic area. Pulmonary gnathostomiasis is often preceded by episodes of migratory swelling over a period of years [21][22][23][24] together with chest symptoms of cough, 19,23−25 varying from paroxysmal dry to violent cough, 25 pleuritic pain, 10,23,24 dyspnea, 22 hemoptysis, 20,22 lobar consolidation or collapse, 21 pleural effusions, 21−23 pneumothorax, 10 and hydropneumothorax. 23 Thoracentesis was performed in a case with pleural effusion, demonstrating exudative pleural fluid with abundant eosinophils.…”

“…The clinical presentations of gnathostomiasis in the human lung were previously described as transient pulmonary lesions with a marked increase in eosinophils in both blood and sputum (Loeffler's syndrome) 7 and spontaneous pneumothorax. 10 To the best of our knowledge, no gnathostomiasis study in humans has demonstrated the parasite in the lung tissue, as all previous diagnoses for pulmonary gnathostomiasis depended on evidence of migratory swelling or cutaneous creeping eruption along with transient abnormal chest radiograph. 7 In the present case, human pulmonary gnathostomiasis was diagnosed by a lung tissue biopsy taken during bronchoscopy supported with confirmatory organismspecific Western blotting, which is the first direct demonstration of Gnathostoma larval migration to the lung in humans.…”

The Tropical Lung

“…Patients do not have overt evidence of congestive heart failure, fluid retention, or peripheral circulatory collapse before the onset of the pulmonary episode. 26,27…”

“…Eosinophilic pleural effusion and hydropneumothorax have occasionally been encountered. [26][27][28]…”