A 28-year-old woman presented with a gradually expanding mass in the inside corner of her left eye, leading to a baffling case for medical professionals. Upon further investigation, it was discovered that the patient had been on a humanitarian mission in the Democratic Republic of Congo where the lump had initially appeared and continued to grow over a period of 2 years. The history revealed that the patient had no prior eye injuries, nor did she exhibit any other symptoms. Despite denying contact with snakes, she admitted to regularly consuming crocodile meat as part of her diet, providing a potential clue to the mysterious mass.
A physical examination unveiled a subconjunctival foreign body in the inner canthus of the eye, prompting the medical team to perform a conjunctival incision. The subsequent extraction led to the discovery of a 10-mm C-shaped larva, identified as Armillifer grandis. This finding raised concerns as pentastomiasis, caused by larval stages of pentastomid parasites, is a rare zoonotic disease that primarily affects individuals living in tropical and subtropical regions. In this instance, the ocular manifestation of the infection was particularly unusual, with very limited documented cases reported in ophthalmologic literature.
Discussion and Implications
Pentastomiasis infections, while often asymptomatic, can lead to severe symptoms as the larvae grow and migrate within the body. In this unique case, the ocular involvement was linked to the consumption of crocodile meat, suggesting a potential source of transmission from infected crocodiles or contaminated snake meat. The authors emphasized the importance of surgical removal of the larvae as the preferred treatment option, cautioning against the use of antiparasitic medication due to potential immune reactions triggered by dying larvae. Preventative measures mainly involve hygiene practices to avoid contact with parasitized snake hosts, undercooked reptile meat, or contaminated food/water sources.
While PCR tests targeting specific parasite genes offer reliable diagnostic methods, access to such resources may be limited in rural endemic regions. Despite the rarity of ocular pentastomiasis, ophthalmologists are urged to consider this diagnosis in patients originating from endemic areas. This case highlights the intricate nature of zoonotic diseases and underscores the need for heightened awareness and vigilance in diverse clinical settings.
The puzzling case of ocular pentastomiasis caused by Armillifer grandis serves as a reminder of the complex interactions between humans and the environment. By dissecting the patient’s history, conducting precise examinations, and employing advanced diagnostic techniques, medical professionals can unravel the mysteries of rare diseases and provide targeted interventions for optimal patient care. As we continue to uncover new challenges in the realm of infectious diseases, proactive measures and interdisciplinary collaborations will be essential in mitigating risks and safeguarding global health.
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