A case of Hymenolepis diminuta in a young male from Odisha
An 18-year-old male, farmer by profession presented to the out-patient department (OPD), for intermittent generalized maculopapular pruritic rash with vague left iliac fossa pain for 4-6 months. Patient had been evaluated by many physicians and dermatologists during this period, but without a final diagnosis. Many attributed this as food allergy (to sea foods). He had received albendazole, ivermectol, cetirizine and even short course oral corticosteroid (prednisolone 1 mg/kg for 10 days). At the time of admission temperature was 98°F, pulse 90/min, blood pressure 130/90 mm Hg and respiratory rate was 18/min. Examination of chest and heart did not reveal any specific abnormality. Abdominal examination did not reveal any significant objective finding. Patient was conscious without any focal neurological deficit. A provisional diagnosis of urticaria was made and thoroughly investigated. The initial laboratory investigation revealed hemoglobin was 10.6 g/dl, otal leukocyte count - 8.8 × 103/cmm, differential count - P68%, L26%, E4% and absolute eosinophil count - 380/cmm, total platelet count 220 × 103/cmm. Erythrocyte sedimentation rate - 46 1st h. Random plasma glucose was 118 mg/dl, blood urea nitrogen - 18 mg/dl, serum creatinine - 0.8 mg/dl, serum Na+- 146 mmol/l, serum K+ - 4.6 mmol/l. Urine examinations did not reveal any abnormality. Stool examination revealed numerous bile stained spherical eggs, 70-80 μm in diameter, which lacked polar filaments and presented a thick shelled outer membrane and a thin inner membrane containing six hooklets suggesting H. diminuta [Figures , and ]. Urine and blood culture were sent for aerobic culture. Allergen challenge test result was awaited. Ultrasonography of the abdomen and pelvis did not reveal any abnormality. At the end of this initial evaluation, we were at a dilemma whether to accept the diagnosis of hymenolepiasis and if at all we accept the diagnosis then how to treat it. We again ordered for the stool test for parasite and the second sample also showed eggs of H. diminuta. Three days later both the urine and blood culture did not grow any organisms and computed tomography scan of abdomen did not provide us any further information. Finally we started treatment in the line of hymenolepiasis and the patient was given praziquantel 1000 g (20 mg/kg) with breakfast on day 0. Post-treatment period was uneventful for 24 h. We discharged the patient with advice to repeat the dose after 7 days and visit the OPD after 1 month. Patient turned up after around 5 weeks and there was no relapse of the symptoms. We again searched for H. diminuta eggs in stool for two consecutive days but both the samples were found negative for any parasite. We followed-up the patient for 6 months at varying intervals and there was no sign of relapse both symptomatically and parasitologically in stool.