gms | German Medical Science

27. Deutscher Krebskongress

Deutsche Krebsgesellschaft e. V.

22. - 26.03.2006, Berlin

Subcutaneous Taenia crassiceps infection in a patient with Non Hodgkin’s lymphoma with prolonged immunosuppression after fludarabine and cyclophosphamide therapy

Meeting Abstract

  • corresponding author presenting/speaker Katharina Heldwein - Klinikum Traunstein-Trostberg, Deutschland
  • Thomas Kubin - Klinikum Traunstein-Trostberg
  • Dennis Tappe - Institut für Hygiene und Mikrobiologie, Universitätsklinikum Würzburg
  • Davide LaRegina - Klinikum Traunstein-Trostberg
  • Gisela Bretzel - Tropeninstitut der Ludwig-Maximilians-Universität München
  • Thomas Löscher - Tropeninstitut der Ludwig-Maximilians-Universität München
  • Dietrich Büttner - Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
  • Hans-Gernot Biedermann - Klinikum Traunstein-Trostberg

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO117

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Veröffentlicht: 20. März 2006

© 2006 Heldwein et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

In the present report we describe the first case of a Taenia crassiceps infection in a patient with underlying malignancy and iatrogenic immunosuppression.

An 82-year-old woman with a history of Non-Hodgkin-Lymphoma (Grade IIIA) was admitted to hospital with progressive pain and swelling of the left forearm and back of the hand. The symptoms had started six weeks before, as the patient had fallen on the left hand. The patient had received 6 cycles chemotherapy with fludarabine and cyclophosphamide until two months before admission to hospital.

The ultrasound and MRI studies revealed a massive oedema of the subcutaneous tissue and multiple well-defined cystic lesions among muscles and tendons of the left forearm and hand.

After admission, the local swelling worsened and the patient developed signs of a compartment syndrome. An emergency fasciotomy was performed. The surgeon removed jelly-like tissue containing multiple spherical masses similar to fish spawns from the subcutaneous tissue and muscles. The histological examination showed larval tissue of Taenia crassiceps. Multiple gelatinous spherical masses, 2 mm in diameter, were removed from the sub-cutaneous tissue, muscles and tendons by 10 incisions. All wounds were left open and healed satisfactory by secondary intention. The patient was additionally given an anthelminthic therapy with albendazole and praziquantel. Albendazole had to be discontinued after 18 days because of a low white cell count. The treatment with praziquantel was given for 28 days.

Until now, only seven cases of human infections with T. crassiceps have been reported world-wide. Four reports were about subcutaneous und muscular infections in patients suffering from severe immunodeficiency due to AIDS. We report on the first T. crassiceps infection in a patient who was immunosuppressed because of an antineoplastic chemotherapy. Probably the patient’s stray dog was the source of T. crassiceps infection. A recurrence of infection was reported in 3 of 4 cases within 6 months despite treatment with praziquantel. Our patient was followed-up for 9 months. Until now, she has neither shown signs of recurrence, nor relapse of lymphoma.

Conclusions: Patients with immunodeficiency are at risk of T. crassiceps infection. The cause of immunodeficiency seems to be negligible. Infected pets are possible transmitters. There is no sureness about the effectivity of conservative medical treatment. In our case surgery seemed to be the most appropriate therapeutical approach. Due to the high rate of recurrence the patient should be followed-up closely.

Figure 1 [Fig. 1]