PMC3336227_01
Clinical picture before and after surgery. Before the removal of the parasite, the patient showed erythematous plaques with mild edema in the lower right abdominal region (a). The ultrasound revealed a well-defined cystic lesion of 11.9 mm x 4.8 mm above muscular layer, which is seen on the right (b). After excision of the nodule the wound healed without complications and all symptoms resolved. The scar reveals the final location of the parasite (c).
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During antiparasitic therapy, the inflammatory abdominal plaque resolved, but a nodule developed deep in the subcutaneous tissue (Figure 1(b)). The nodule was excised, and all signs of infection including the eosinophilia subsided, and no further symptoms developed (Figure 1(c)).
Histological sections of the parasite. Sections were stained using hematoxylin-eosin (HE) (a), Masson's trichrome stain (b, c), Giemsa (d, e), and periodic acid-Schiff reaction and immunohistochemistry for IgE (f). Typical features of D. repens are the external longitudinal ridges, the thick cuticula, and the well-developed musculature (a, b, c). Around the parasite a marked inflammatory reaction with numerous eosinophils, neutrophils, lymphocytes, plasma cells, and macrophages is seen (d, e). Many IgE-positive plasma cells are present in the infiltration and near to the surface of the parasite (f).
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The excised material was investigated histopathologically using hematoxylin-eosin (HE), Giemsa, and Masson's trichrome stains, periodic acid-Schiff reaction, and immunohistochemistry for IgE (Figure 2). The most indicative structures were the external longitudinal ridges, leading to a cogwheel-like appearance in the transverse sections (Figures 2(a), 2(b), and 2(c)). Further typical features were the thick cuticula and the well-developed musculature (Figures 2(a) and 2(c)). Around the parasite a marked inflammatory reaction had developed (Figures 2(d) and 2(e)). The histological slides showed numerous eosinophils, neutrophils, lymphocytes, plasma cells, and macrophages. (Figures 2(d) and 2(e)). Occasionally, eosinophils and neutrophils, partly with pycnotic nuclei, were seen on the surface of the parasite (Figures 2(d) and 2(e)). Many IgE-positive plasma cells were present in the infiltration and near to the surface of the parasite (Figure 2(f)).