The Traveling Edema
Clinical Vignette
A 37-year-old man presents with recurrent, painful edema of the right forearm and cheek. The edema first appeared 3 weeks after returning from a trip to coastal Mexico, where he ate several dishes made with raw fish and shrimp. The first episode resolved spontaneously after 5 days, but a new area of edema appeared 2 weeks later near the jaw.
He describes a deep piercing sensation just before each area of edema becomes visible. He has had intermittent nausea and mild epigastric discomfort since the trip, but no diarrhea. He does not take immunosuppressive medications and has no prior history of angioedema or chronic skin disease.
Examination shows a firm, non-pitting, mildly erythematous subcutaneous edema over the left mandibular region. There is no urticaria, wheezing, or lip edema. Her white blood cell count is 11,900 cells/uL with eosinophils 18% (absolute eosinophil count 2,100 cells/uL). Stool ova and parasite examination is negative.
Migratory mandibular edema.
Question
Which of the following is the most likely diagnosis?
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Question 2
Which treatment approach is most appropriate for uncomplicated cutaneous gnathostomiasis when the larva is not easily accessible?
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References
Dekumyoy P, Watthanakulpanich D. Gnathostomiasis. In: Hunter's Tropical Medicine and Emerging Infectious Diseases. 121:888-890.
Sharma C, Piyaphanee W, Watthanakulpanich D. Clinical features of intermittent migratory edema caused by gnathostomiasis with complete follow-up. American Journal of Tropical Medicine and Hygiene. 2017;97:1611-1615.