The Chemosis of Trichinosis

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     A 45-year-old man was admitted to the hospital because of a fever (temperature, 40°C), myalgia, and headache. He did not have diarrhea. On examination, he had bilateral proptosis with chemosis (Panel A) and eyelid edema. He had no trismus or subungual splinter hemorrhages. The white-cell count was 17,500 per cubic millimeter, and the differential count included 14 percent eosinophils (2450 per cubic millimeter). The serum creatine kinase level was 651 U per liter (normal range, less than 170 U per liter). An initial serologic test for trichinosis with the use of an enzyme-linked immunosorbent assay was negative (value, 0.09; a value of less than 0.3 indicates a negative result for trichinosis, and a value of greater than 0.5, a positive result). A computed tomographic scan of the orbits (Panel B) showed bilateral proptosis (the posterior part of the eyes, indicated on one side by an arrowhead, is normally at the level indicated by the arrow below it) and moderate ocular-muscle hypertrophy (arrows). Trichinosis was suspected because of a trichinosis epidemic in Toulouse, France, at the time. The patient's history indicated that he had eaten raw horse meat 10 days before the symptoms occurred. The patient was treated with corticosteroids (1 mg per kilogram of body weight) and albendazole (10 mg per kilogram) for 10 days, and there was rapid improvement of the ocular signs. Two months later, the serologic test for trichinosis became positive (value, 2.25). By that time, the patient was asymptomatic.

    Leonardo M. Astudillo, M.D.

    Philippe M. Arlet, M.D.

    Centre Hospitalier Universitaire Purpan

    31059 Toulouse, France

    http://www.100md.com/html/DirDu/2006/11/29/30/48/80.htm