Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4803-4809
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4803
Cutaneous myiasis with eosinophilic pleural effusion: A case report
Tao Fan, Yu Zhang, Yan Lv, Jing Chang, Brent A Bauer, Juan Yang, Cheng-Wei Wang
Tao Fan, Yan Lv, Jing Chang, Cheng-Wei Wang, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Yu Zhang, Department of Respiratory and Critical Care Medicine, Chengdu Integrated Traditional Chinese and Western Medicine Hospital, Chengdu 610016, Sichuan Province, China
Brent A Bauer, Juan Yang, Department of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Fan T and Wang CW initially conceived this case report, participated in collecting data, and drafted the manuscript; Zhang Y and Lv Y performed the data analysis and participated in its design; Chang J helped to draft the manuscript; Bauer BA and Yang J revised this manuscript; All authors reviewed and approved the final manuscript.
Supported by Key Project of Science and Technology Agency of Sichuan Province, China, No. 2020YFS0149.
Informed consent statement: The patient’s legal guardian provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cheng-Wei Wang, MD, Doctor, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu 610041, Sichuan Province, China. wangchengwei@wchscu.cn
Received: January 15, 2021
Peer-review started: January 15, 2021
First decision: March 27, 2021
Revised: April 7, 2021
Accepted: May 6, 2021
Article in press: May 6, 2021
Published online: June 26, 2021
Abstract
BACKGROUND

Cutaneous myiasis is frequently observed; however, eosinophilic pleural effusion induced by this condition is rare.

CASE SUMMARY

We report the case of a 65-year-old female Tibetan patient from Qinghai Province, who presented to West China Hospital of Sichuan University around mid-November 2011 with a chief complaint of recurrent cough, occasional hemoptysis, and right chest pain. There was no past medical and surgical history of note, except for occasional dietary habit of eating raw meat. Clinical examination revealed a left lung collapse and diminished breathing sounds in her left lung, with moist rales heard in both lungs. Chest X-rays demonstrated a left hydropneumothorax and a right lung infection. Chest computed tomography revealed a left hydropneumothorax with partial compressive atelectasis and patchy consolidation on the right lung. Laboratory data revealed peripheral blood eosinophilia of 37.2%, with a white blood cell count of 10.4 × 109/L. Serum immunoglobulin E levels were elevated (1650 unit/mL). Serum parasite antibodies were negative except for cysticercosis immunoglobulin G. Bone marrow aspirates were hypercellular, with a marked increase in the number of mature eosinophils and eosinophilic myelocytes. An ultrasound-guided left-sided thoracentesis produced a yellow-cloudy exudative fluid. Failure to respond to antibiotic treatment during hospitalization for her symptoms and persistent blood eosinophilia led the team to start oral albendazole (400 mg/d) for presumed parasitic infestation for three consecutive days after the ninth day of hospitalization. Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported; tender nodules and worm-like live organisms were observed in the responding sites 1 wk later. After the removal of the live organisms, they were subsequently identified as first stage hypodermal larvae by the Sichuan Institute of Parasites. The patient’s symptoms were relieved soon afterwards. Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved.

CONCLUSION

Eosinophilic pleural fluid can be present in a wide array of disorders. Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed.

Keywords: Cutaneous myiasis, Eosinophilic pleural effusion, Hypoderma larvae, Albendazole, Case report

Core Tip: Eosinophilic pleural fluid can be present in a wide array of disorders. This condition generally occurs in patients due to the presence of air or blood in the pleural space or infections, or when patients are in a hypersensitive state or during malignancy. Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed.