Parasitic Diseases: | Case 1 | Case 2 | Case 3 | Case 4

Case 1 (by Chan, T K & Chan, Helen)

Patient: 10 years old Oriental boy
( Expatriate family; been in Hong Kong for 4 years )

Source: Hong Kong, 1997

Presenting features:
  Painful bruises on shins, right elbow and right eye lid x 2 wks.
  No petechiae, lymphadenopathy, nor hepatosplenomegaly.
  Baseball enthusiast and played every weekends in open fields previously occupied by vegetable farms.

Relevant Investigations:
  Hb 12.9 gm/dl; WBC 11.2 x 109/L with 48% eosinophils; platelets 116 x 109/L; coagulation screening normal.
  Marrow biopsy: normoblastic hyperplasia; free iron negative; marked increase in eosinophils.

Problems:
  Marked eosinophilia ( peripheral blood and marrow )
  Iron deficiency
  Multiple bruises - ? due to eosinophilia

Progress:
  Stool - occult blood +; hookworm ova ++
  Responded well to Combantrin ( 11 mg/kg x 3 days )
  With eradication of hook worms and subsidence of eosinophils & bruising

Lessons:
1) Marked eosinophilia should suggest search for parasites.
2) Clue to Diagnosis was co-existing iron deficiency.
3) Hook worm infestation in an urban boy due to multiple injuries in a field previously used for vegetable farming.

Case 1 | Case 2 | Case 3 | Case 4