A Case of Lagochilascariasis in Suriname with the Involvement of the ENT System and the Skull Base

Abstract

Abstract. We describe a case of human lagochilascariasis, with skull-base involvement and a chronic and relapsing course after treatment. This rare parasitic infection is usually manifested in the head and neck area, characterized by progressive granulomatous inflammation and the formation of abscesses. Transmission to humans most likely occurs by the consumption of undercooked meat of wild rodents. On the basis of literature studies, we propose the most likely life cycle of the parasite that involves wild feline and rodent species, with humans as accidental hosts. Even in endemic areas, it is very difficult to recognize the disease at an early stage. Progression will eventually lead to involvement of the (central) nervous system, as described in our case. Treatment is often difficult and involves resection and prolonged treatment with anthelmintic drugs. Recurrences are not uncommon and at present, long-term oral administration of ivermectin seems to be the most effective treatment.

Unusual case of lagochilascariasis with breast involvement: the first case report in pregnancy

“…According to the literature review, cases mostly occur in cervical and mastoid regions, paranasal sinuses, middle ear, rhinopharynx, oropharynx and skull base. There are also cases described of lesions in the central nervous system, sacral region, eyeballs, Eustachian tube, chin, submandibular and supraclavicular regions, scapular muscles, cervical vertebrae, dental alveoli, lungs, cranial nerves, among others 2,3,5,7,[10][11][12] . In this case report the patient also presented with involvement of thoracic spinal vertebrae.…”

“…Identification is usually, and in this report, based on the finding of the nematode parasite eggs (Figure 2A), larvae ( Figure 2B) and adult parasites ( Figure 2C) in lesion secretions. The lagochilascariasis etiologic agent, L. minor, is a small ascarid nematode of up to 20 mm in the adult form, milky white in color and a mouth trimmed by three welldeveloped lips, separated by interlabial membranes, which give the end of the head a characteristic aspect reminiscent of a cleft lip (lago = hare; chil = lip) ( Figures 2B and 2C) 2,6,11,12 .…”

“…In 2001, there was a case described of a young female patient from Roraima State (Brazil) whose evolution included erosion of the occipital bone and of the first cervical vertebra on tomographic examination 19 . In 2016, a case of a patient in Suriname with base of the skull involvement and chronic recurrence after treatment was reported 11 .…”

“…The lagochilascariasis etiologic agent, L. minor , is a small ascarid nematode of up to 20 mm in the adult form, milky white in color and a mouth trimmed by three well-developed lips, separated by interlabial membranes, which give the end of the head a characteristic aspect reminiscent of a cleft lip (lago = hare; chil = lip) ( Figures 2B and 2C ) 2 , 6 , 11 , 12 .…”

“…In 2001, there was a case described of a young female patient from Roraima State (Brazil) whose evolution included erosion of the occipital bone and of the first cervical vertebra on tomographic examination 19 . In 2016, a case of a patient in Suriname with base of the skull involvement and chronic recurrence after treatment was reported 11 . The involvement of the spine was also noteworthy in this patient, more specifically the simultaneous involvement of three thoracic vertebrae (T3-T5), probably due to the spread and long evolution of the helminthiasis without treatment.…”