Make the Diagnosis: Eye Surprise

Presentation

Case Findings: A 35-year-old physician participating in Doctors Without Borders returned from a trip to Africa and developed localized pain and itching followed by arthritic pain and swelling that lasted for several weeks. He visited his primary care physician, who saw the image below during a routine eye examination.

What time of day should blood samples be collected to have the highest chance of obtaining a diagnosis of this parasitic infection?

Learnings

Correct Answer:

C. The patient was diagnosed with loaisis, and the best time to obtain a blood sample is during midday when peak parasitemia occurs. Many patients who are infected with Loa Loa are asymptomatic and do not have microfilaremia. Their infections are characterized by subcutaneous edemas that develop rapidly over a few hours, often after the patients report localized pain, pruritis and urticaria. The swelling can last from several days to several weeks. The migration of these adult worms through the body is not painful, and thus rarely noticed, except when the worms migrate across the bridge of the nose, and particularly through the conjunctiva.

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Make the Diagnosis: Eye Surprise