Multiple brain hemorrhages and hematomas associated with ectopic fascioliasis in brain and eye.
BACKGROUND
Fascioliasis is a parasitic infection caused by Fasciola hepatica. Human beings can be infected accidentally by an ingestion of the metacercariae; and the parasite exists almost persistently in the bile ducts, but rarely in other organs. We report an interesting case of ectopic fascioliasis in both the brain and the right eye of a school-aged boy, which was associated with 2 unruptured intracranial aneurysms. To our knowledge, no case report such as this has been found in the medical literature.


METHODS
After an ingestion of Potamon denticulata (a fresh crab) for 4 months, a 10-year-old boy presented with neurologic manifestations caused by 5 episodes of intracranial hemorrhages and hematomas. The boy simultaneously suffered repeated affliction in the right eye accompanied by headache, vomiting, ophthalmalgia, exophthalmos, and abducens nerve palsy. Digital subtraction angiography revealed 2 unruptured intracranial aneurysms. The definitive diagnosis of this case had been confirmed by an observation of the parasite moving out of the patient's swelling conjunctiva and by the results of the laboratory tests. The patient was treated with praziquantel and completely recovered. The 2 aneurysms were not surgically treated but underwent a long-term follow-up. The follow-up DSA revealed that one aneurysm disappeared but the other remained unchanged.


CONCLUSIONS
Multiple brain hemorrhages and hematomas can be associated with ectopic fascioliasis in brain and eyes. An intracranial infection occasionally caused by F hepatica or other parasites can be indicated by a fever of unknown origin, eosinophilia, and iterative intracranial hemorrhages. Ingestion of P denticulata may be an uncommon transmission route of fascioliasis. Fascioliasis can be successfully treated.
Zhou
Liangxue
L
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, 610041 China.
Luo
Lingli
L
You
Chao
C
Wang
Bing
B
Xu
Jianguo
J
Liao
Lin
L
Hui
Xuhui
X
Cai
Bowen
B
D000871:Anthelmintics / Q000627:therapeutic use; D020809:Central Nervous System Helminthiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D002648:Child; D015822:Eye Infections, Parasitic / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005211:Fascioliasis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D006406:Hematoma / Q000469:parasitology*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000469:parasitology*; D008297:Male; D011223:Praziquantel / Q000627:therapeutic use
D000871:Anthelmintics; D011223:Praziquantel