Vasculitis secundaria a infección por Fasciola hepática

Abstract

There is a case of a 38 year-old male patient coming from an area where hepatic fascioliasis is endemic in Peru. He was hospitalized because he showed 4 weeks of symptoms like fever, intense myalgias, erythematous and painful injuries on limb extensions. The electromyography and nerve conduction velocity showed a global inflammatory myopathy. A skin biopsy showed polyarteritis nodosa-type vasculitis. During the evaluation process prior to the immunosuppressive therapy, hepatic Fasciola eggs were found in the parasitological examination of stools. The fascioliasis diagnosis was confirmed by fas2-ELISA: 0.46 (VN <0.20). Clinical symptoms started to subside after treatment with ticlabendazol. Contact with the patient was maintained for a year and there was no evidence of disease recurrence, and he was asymptomatic.

Neurological and Ocular Fascioliasis in Humans

“…However, cephaleas have also been many times reported in patients diagnosed during the biliary phase (Ahualli and Arias, 1961;Berenger, 1984;Birjawi et al, 2002;Cames et al, 1947;Carena et al, 1972;Domart et al, 1967;Dunet, 1924;Garde et al, 1961;Málaga et al, 2012;Mendoza, 1922;Patrick and Isaac-Renton, 1992;Pesse and Atias, 1956;Ragab and Farag, 1978;Sonzini Astudillo et al, 1973;Strada, 1961;Torrealba, 1922), sometimes even in the very advanced chronic stage, after many years postinfection or a long time after from the first typical symptoms, as 8 years (Bello, 1916;Stemmermann, 1953), 10 years , 11 years (Desage, 1926), 12 years (Del Valle and Donovan, 1928), or even 15 years (Padilla Antoni et al, 1970). Whether on the invasive phase or in the biliary phase, when the patient was treated with a specific fasciolicide drug such as emetine or dehydroemetine, cephaleas regressed rapidly, thus proving to be related to Fasciola infection (Berenger, 1984;Guyot, 1962).…”

“…In other reports, cephaleas were found to mainly appear or increase during night (Coulaud et al, 1970;Saimot et al, 1971) as to give rise to nocturnal vomiting (Berenger, 1984). In several cases, cephaleas were noted be persistent (Cames et al, 1947;Desage, 1926;Málaga et al, 2012;Nuñez Fernández et al, 2001;Wang et al, 2007;Ying et al, 2007), intermittent and appearing in episodes or recurrent (Schussele and Laperrouza, 1971a,b;Stemmermann, 1953), intense (Arjona et al, 1995;Brouet et al, 1951;Cames et al, 1947;Dejean, 1960;Dunet, 1924;Guyot, 1962;Mendoza, 1922), or violent (Berenger, 1984;Desage, 1926). When of long duration, severe cephaleas may be of only 1 week (Birjawi et al, 2002), 3 weeks (Brouet et al, 1951), 1 month (Dunet, 1924), 2 months (Ahualli and Arias, 1961), 5 months (Domart et al, 1967), 1 year (Ragab and Farag, 1978), or even 15 years (Cames et al, 1947).…”

“…(F) Neurological pains and sciatica: Pains in different parts of the body have frequently been reported from neurological patients infected by Fasciola. In all the reports, the disorders are simply described as pains, without evoking its origin (neuropathic pains and neuralgias), and in several cases, they are referred to as diffuse myalgias (Coulaud et al, 1970;Saimot et al, 1971) or myalgias in the limbs, mainly the lower ones (Málaga et al, 2012), although in the latter cases, neurological pains may have been probably interpreted as muscular.…”

“…Many of them may be considered mild manifestations: -Blurred vision (Domart et al, 1967) -Sudden bilateral reduction of the visual acuity (Oujamaa et al, 2003) -Eye-roll sign (Coumbaras, 1966) -Retro-ocular pain and unilateral exophthalmos (Arias et al, 1986) -Unilateral haemorrhage in the lamina cribrosa (Málaga et al, 2012) Other disorders become worrying, such as the following: -Transitory or intermittent diplopia (Domart et al, 1971;Garde et al, 1961; case 1 of Berenger, 1984;Málaga et al, 2012) -Unilateral concentric narrowing of the field of vision (case 1 of Berenger, 1984) -Disorders of the visual accommodation (Domart et al, 1967) -Nystagmus, from simple (Bothier et al, 1968;Kristoferitsch et al, 1982; case 1 of Berenger, 1984;Ayadi et al, 1991) to extremely intense (Garde et al, 1961) And finally, others become serious problems: -Visual hallucinations (Aimard et al, 1984) -Visual deformation of objects and superimposition of geometric images, as signs of occipital affection (Coulaud et al, 1970;Saimot et al, 1971) -Loss of bilateral vision (Llanos et al, 2006), which may become almost complete vision loss (Aguilar et al, 1967(Aguilar et al, , 1968) -Amaurosis, from transient (Ayadi et al, 1991) to permanent (Arias et al, 1986;Becquet and Delassus, 1961) and noted to be due to ophthalmoneuritis (Becquet and Delassus, 1961) Ocular manifestations have been found in both the invasive phase (Domart et al, 1967; case 1 of Berenger, 1984;Arias et al, 1986;Ayadi et al, 1991;Llanos et al, 2006;Oujama et al, 2003) and the biliary phase of the disease (Aguilar et al, 1967…”

“…However, in other cases, patients with major neurological manifestations recovered only after fasciolicide treatment (Bernheim et al, 1958; two cases of Kouri et al, 1938;Lemoine, 1954; case 2 of Dejean, 1960;Garde et al, 1961;Aguirre Errasti et al, 1981;Auer et al, 1982;Domart et al, 1971;Gil et al, 1970; cases 2 and 3 of Guyot, 1962;Kristoferitsch et al, 1982;Lefevre et al, 1970;Lesecq et al, 1972;Paraf et al, 1967; case 1 of Berenger, 1984;Ait Ali et al, 2002;Ayadi et al, 1991;case 8 of Campo et al, 1984a;Frances et al, 1994;Linares et al, 2006;Llanos et al, 2006;Málaga et al, 2012;Oujamaa et al, 2003;Park and Sohn, 2010;Pelletier et al, 1995).…”