Atypical trichinellosis without eosinophilia associated with osteomyelitis

Human trichinellosis is an important food-borne zoonosis caused by a nematode worm, Trichinella. The symptoms of the disease vary widely depending on the infection load, stage of infection and host immunity and include nausea, vomiting, abdominal pain, fever, facial edema and muscle pain. The disease is usually characterized by moderate to high eosinophilia. We hereby discuss an atypical case of trichinellosis, which presented with myositis of the thigh muscles but had no eosinophilia and no facial or periorbital edema and was associated with osteomyelitis of the femur. The diagnosis was made by the demonstration of anti-trichinella antibodies and later confirmed by the presence of larvae of Trichinella in the digested muscle biopsy. Physicians must be aware of trichinosis and should include it in their differential diagnosis when examining patients with fever and myositis with or without eosinophilia.