[African eye worm as initial manifestation of loaiasis].

HISTORY AND CLINICAL FINDINGS

A 23-year-old woman suddenly had the sensation of a foreign body in her right eye. On looking into the mirror she saw what looked like a moving worm-like structure in the lateral angle of the eye. The patient had visited Cameroon 2 years previously.

TESTS

On ophthalmological examination with a slit-lamp a transparent worm, 6-7 cm long, was seen. Laboratory tests showed an eosinophilia of 13%, C-reactive protein slightly raised to 1.25 mg/dl and IgG of 2100 mg/dl (IgE was normal at 33 U/ml). Giemsa staining of a whole-blood drop contained numerous microfilaria typical of Loa loa (2000/ml). Filaria serology with antigen of Dipetalonema vitae (Acanthocheilonema) gave a positive response.

TREATMENT AND COURSE

The worm was removed surgically and, after a test dose, diethylcarbamazine, 6 mg/kg daily), was administered. Although methylprednisolone (initially 20 mg daily) was given concurrently, a fever of 38,5 degrees C developed on the 4th day. At the same time, streaky cutaneous eruptions were noted over the left lower arm and left knee bond. These two signs, which were due to two adult worms, disappeared within 2 days. On the 5th day the patient complained of headache, nausea and sensitivity to light, and she had meningism. The symptoms were treated with paracetamol and diazepam and quickly improved. The patient was discharged after 3 weeks. Further treatment cycles with diethylcarbamazine are planned.