In the world of medicine, there are certain cases that leave even the most seasoned professionals scratching their heads. One such case involves a healthy 28-year-old woman who presented with a gradually expanding mass in the inside corner of her left eye. Dr. Grégoire Van Acker and his colleagues at Cliniques Universitaires Saint-Luc in Brussels found themselves faced with a puzzling situation as they delved into the patient’s history.
The young woman explained that she had been on a humanitarian mission in the Democratic Republic of Congo when the lump first appeared 2 years ago. Since then, it had been increasing in size continuously. Despite never experiencing an eye injury or any other symptoms, the patient’s physical examination revealed a subconjunctival foreign body in the inner canthus of her eye.
A Shocking Discovery
Upon performing a conjunctival incision, Dr. Van Acker and his team discovered a 10-mm C-shaped larva with several annulations. The larva, identified as Armillifer grandis, was promptly removed and sent for testing at the National Reference Center of Tropical Pathogens in Germany. Polymerase chain reaction (PCR) testing confirmed the presence of the pentastomid parasite, shedding light on the unusual case.
Pentastomiasis is a rare zoonotic disease caused by the larval stages of pentastomid parasites. In humans, infection typically occurs in tropical and subtropical regions, with eye involvement being particularly uncommon. This patient’s case marks a significant contribution to the medical literature on ocular pentastomiasis, and highlights the importance of considering rare diseases in clinical practice.
Surgical removal of the larvae is the preferred treatment for pentastomiasis, as antiparasitic medications may trigger a severe immune response upon larval death. Preventative measures include avoiding close contact with parasitized snake hosts, consuming undercooked reptile meat, and ingesting food or water potentially contaminated with snake feces or pentastomid eggs. While diagnostic tests like PCR can aid in identifying pentastomid infections, access to such resources may be limited in rural regions.
The case of ocular pentastomiasis in a young woman with a history of consuming crocodile meat serves as a stark reminder of the diverse range of pathogens that can affect human health. Dr. Van Acker’s team’s diligent efforts in diagnosing and treating this rare condition emphasize the importance of thorough investigation and consideration of uncommon diseases. As ophthalmologists worldwide continue to encounter patients from endemic regions, awareness of diseases like pentastomiasis becomes crucial in ensuring timely and accurate management.
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