Right Testicular Artery Occlusion and Acute Appendicitis byAngiostrongylus costaricensis

Abstract

Introduction. Angiostrongylus costaricensis is a nematode from the superfamily Metastrongyloidea, whose etymology is “roundworm that lives in blood vessels”. This parasite can be found from the southern United States to northern Argentina and southern Brazil. In 1983, Morera and Ruiz published the first case of a testicular artery occlusion by A. costaricensis. Case Presentation. A five year old boy presented with eight days of pain, denying trauma backgrounds and followed with an increase of volume. The treatment was a right simply orchiectomy, finding necrosis of the testicle, the biopsy showed reddish-purple aspect and soft consistency. Histologic studies reveled the presence of a worm inside the testicular artery. Conclusion. The diagnosis of A. costaricensis infection should be considered in all pediatric patients, with signs and symptoms of orchitis or acute abdomen, from endemic areas, may cause occlusion of the testicular artery and appendicular artery causing testicular and cecal appendix necrosis, respectively, even putting the patient’s life at risk. The diagnosis is complex, because the clinical manifestations are similar to an orchitis or acute abdomen, therefore, the definitive diagnosis is made during the surgical intervention and histopathological study.

Abdominal angiostrongyliasis in the Americas: fifty years since the discovery of a new metastrongylid species, Angiostrongylus costaricensis

“…AA is characterized by a strong inflammatory response involving mainly the ileocecal region [ 115 ]. Other anatomical regions reported to be affected by A. costaricensis -mediated inflammation include the liver, testicles, omentum, abdominal wall hernia, and colon [ 33 , 69 , 116 ]. The presence of eggs and adult worms triggers a strong type 2 inflammatory response characterized by the formation of eosinophilic granulomas and vasculitis leading to tissue damage.…”

Case report: First documented case of cerebral angiostrongyliasis caused by Angiostrongylus costaricensis in a free-ranging opossum

“…Previous studies have associated A. costaricensis infection in wild species with the development of granulomatous lesions in mesenteric arteries, as it normally occurs in humans ( 14 , 15 , 27 ). Prior case reports have documented an aberrant migration of this parasitic nematode within human testicular and hepatic tissues, eliciting accompanying inflammatory responses ( 8 , 28 ). Despite the considerable diagnostic challenges posed by neuroangiostrongyliasis, previously reported cases in both humans and wild species, have consistently exhibited presumptive associations with A. cantonensis ( 27 , 29 ).…”

A practical guide for the diagnosis of abdominal angiostrongyliasis caused by the nematode Angiostrongylus costaricensis

“…These clinical manifestations are explained by the presence of adult worms in arteries and the strong eosinophilic response induced in situ. Extraintestinal complications are less frequently reported, but may include nodular hepatic lesions [ 17 ] or testicular necrosis [ 18 ]. In this guide, we propose a diagnostic flowchart to aid clinicians in the diagnosis of AA (Fig.…”