Patient: 10 years old Oriental boy
(
Expatriate family; been in Hong Kong for 4 years )
| Parasitic Diseases: | Case 1 | Case 2 | Case 3 | Case 4 |
Case 1 (by Chan, T K & Chan, Helen)
|
Patient: 10 years old Oriental boy |
|
| Source: Hong Kong, 1997 |
|
| Presenting features: | |
| Painful bruises on shins, right elbow and right eye lid x 2 wks. | |
| No petechiae, lymphadenopathy, nor hepatosplenomegaly. | |
| Baseball enthusiast and played every weekends in open fields
previously occupied by vegetable farms. |
|
| Relevant Investigations: | |
| Hb 12.9 gm/dl; WBC 11.2 x 109/L with 48% eosinophils; platelets 116 x 109/L; coagulation screening normal. | |
| Marrow biopsy: normoblastic hyperplasia; free iron negative; marked increase
in eosinophils. |
|
| Problems: | |
| Marked eosinophilia ( peripheral blood and marrow ) | |
| Iron deficiency | |
| Multiple bruises - ? due to eosinophilia |
|
| Progress: | |
| Stool - occult blood +; hookworm ova ++ | |
| Responded well to Combantrin ( 11 mg/kg x 3 days ) | |
| With eradication of hook worms and subsidence of eosinophils & bruising |
|
| Lessons: | |
| 1) | Marked eosinophilia should suggest search for parasites. |
| 2) | Clue to Diagnosis was co-existing iron deficiency. |
| 3) | Hook worm infestation in an urban boy due to multiple injuries in a field previously used for vegetable farming. |