Limb swelling with hypereosinophilia.

摘要

In July, 2005, a 28-year-old white man was referred to our unit with a 3-month history of recurrent painful asymmetrical swelling and induration of the limbs (figure, A). His history was otherwise unremarkable. On physical examination, the skin was too taut to pinch. The rest of the examination was normal, and there was no pruritus. 8 months previously he had spent 6 weeks travelling in several African countries. Blood test results showed hypereosinophilia (4-69xl0~9/L). Liver function tests were normal, and C-reactive protein was below 8 mg/L. Rheumatoid factor was negative, and total complement, C3 and C4 concentrations, and anti-DNA antibody titres were normal. Stool examination for ova and larvae was negative. No microfilariae were detected in peripheral blood. The serum antifilarial titre was 1 in 200 by direct immunofluorescence (normal: less than 1 in 200), and electrosyneresis was negative. Serological tests for schistosoma, toxocara, distomatosis, and trichina were negative. Hepatic ultrasonography was normal. MRI of the affected limb showed increased signal intensity within the superficial and deep fascia (figure, B).We made a presumptive diagnosis of onchocerciasis with limb swelling, and treated our patient with ivermectin (8 mg), after which the swelling rapidly subsided. Two further doses were followed by the disappearance of hypereosinophilia after 6 months of follow-up. Tests for antifilarial antibodies by direct immunofluorescence became positive (1 in 800) after 4 weeks, and one arc appeared on electrosyneresis. When last seen, in May, 2006, the patient had no further symptoms.