A 28-year-old woman presented with a gradually expanding mass in the inside corner of her left eye, leaving doctors puzzled at the cause behind this unusual development. This case, reported in JAMA Ophthalmology by Grégoire Van Acker, MD, and his team at Cliniques Universitaires Saint-Luc in Brussels, sheds light on a rare ocular infection linked to pentastomid parasites and consumption of crocodile meat.
The patient, who had been on a humanitarian mission in the Democratic Republic of Congo, noticed the lump 2 years ago which had been increasing in size ever since. She denied any eye injuries and was asymptomatic apart from the presence of the mass. However, upon further investigation, it was revealed that she consumed crocodile meat regularly as part of her diet.
A physical examination revealed a subconjunctival foreign body in her eye, which was later identified as a 10-mm C-shaped larva of the Armillifer grandis parasite. The team performed a conjunctival incision to extract the larva, which was sent for testing at the National Reference Center of Tropical Pathogens in Germany. Polymerase chain reaction (PCR) testing confirmed the identity of the parasite.
Pentastomiasis is a rare zoonotic disease caused by pentastomid parasites, primarily found in tropical and subtropical regions. Infections in humans are often asymptomatic but can lead to symptoms as the larvae grow and migrate within the body. The case of ocular pentastomiasis associated with consumption of crocodile meat is a unique occurrence, highlighting the importance of considering unusual infections in patients with relevant travel history.
Prevention of pentastomiasis involves avoiding contact with parasitized snake hosts, undercooked reptile meat, and contaminated food or water. The primary treatment is surgical removal of the larvae, as antiparasitic medications may induce a severe immune response due to the release of antigens from dying larvae. Diagnosis relies on morphological criteria, histopathology findings, and PCR testing, although access to such resources may be limited in rural endemic regions.
While ocular pentastomiasis is a rare occurrence, this case serves as a reminder for ophthalmologists to consider unusual infections in patients with travel history to endemic regions. The association with crocodile meat consumption in this case highlights the diverse sources of zoonotic infections and the need for vigilance in diagnosing and treating such cases.
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