Infestation from Lagochilascaris minor in Mexico

An 11-year-old girl presented from Villa Azueta, Veracruz, a poor and small town on the Tesechoacan riverside. The Tesechoacan riverside is a tropical area in the south-east of Mexico, between 18 degrees, 04',32" latitude and 95 degrees, 42',23" longitude. Her family consisted of both parents and 12 brothers, all apparently healthy and living in a humble hut, with poor nutrition and hygiene. The main sign was a tumor on her neck that had developed during the previous 6 months. On clinical examination, the patient's temperature was normal and her weight was 27.5 kg. Below the right angle of the jaw a firm-to-hard tumor was noted measuring 5 x 3 cm, it was tender and lobulated (Fig. 1) with a central purulent fistula containing small worms with morphology of Lagochilascans minor (Fig. 2). Iron-deficiency anemia was found with no increase of blood eosinophils and a while blood count of 9000/mm3 with 72% of neutrophils. Roentgenograms of the head and chest were both normal. A stool was negative for parasites; glutamic oxalade and glutamic pyruvate transaminases were normal. Histopathologic examination revealed parakeratosis and mild acanthosis with exocytosis of eosinophils. The superficial dermis showed an inflammatory reaction, mainly composed of eosinophils, plasma cells, and histiocytes, and in the deep dermis an abscess containing different sections of the parasite was seen surrounded by a thin fibrous capsule (Fig. 3). There was no clinical improvement after medical treatment with two courses of thiabendazole (50 mg/kg orally, two 5-day pulses) and praziquantel (400 mg orally for 3 days). Therefore, the growth was extirpated under general anesthesia; however, the clinical condition of the patient did not improve. Eggs, larvae, and adult worms continued to be present in the pus after surgical excision. Finally, the patient asked for a discharge and did not return to the institute.