هيپرائوزينوفيلي در كودك سه ساله: گزارش موردي

Hypereosinophilia in a three-year-old child: case report

زمينه و هدف: هايپرائوزينوفيلي مي‌تواند در بيماري‌هاي متفاوتي مانند آلرژي، انگلي و بدخيمي‌ها ديده مي‌شود. فاسيولوزيس با نماي باليني متفاوتي تظاهر كرده كه باعث دشواري در تشخيص مي‌شود. از تظاهرات آزمايشگاهي آن، ائوزينوفيلي مي‌باشد. هدف از اين گزارش، معرفي كودك سه ساله‌اي است كه با هيپرائوزينوفيلي مراجعه و در نهايت با تشخيص فاسيولوزيس درمان شد. معرفي بيمار: بيمار دختر سه ساله به‌علت تب طول كشيده و درد شكم به‌مدت دو هفته، بستري شد. در سونوگرافي شكم، اسپلنومگالي و در آزمايشات هايپرائوزينوفيلي داشت. توموگرافي كامپيوتري شكم، لنف‌نودهاي پاراآئورتيك متعدد و فلوسيتومتري آسپيراسيون مغز استخوان، افزايش رده ائوزينوفيل داشت. درنهايت با توجه به سرولوژي مثبت ضعيف فاسيولاهپاتيكا، باوجود عدم مشاهده تخم فاسيولا در مدفوع، با تشخيص فاسيولوزيس، تريكلابندازول براي وي شروع شد. حين بستري، تب قطع و ائوزينوفيلي كاهش يافت. نتيجه‌گيري: در بيماران هيپرائوزينوفيلي، بيماري‌هاي انگلي از جمله فاسيولوزيس، حتي در صورت منفي بودن مدفوع از نظر انگل، مدنظر قرار گيرد.

Background: Hypereosinophilic syndrome is commonly found in various diseases such as allergic diseases, parasitic diseases, malignancies, etc. Fasciolosis may present with different clinical features, and it can make a difficult diagnosis of the disease. Laboratory manifestations of fascioliasis are eosinophilia. The purpose of this report was to introduce a child with hypereosinophilia that her diagnosis was fascioliasis. Case Presentation: The patient was a 3-year-old girl who was referred for prolonged fever (more than two weeks) and abdominal pain from another medical center, and she was hospitalized. In abdominal and pelvic ultrasound, splenomegaly was seen and in laboratory tests, she had hypereosinophilia. In the flow cytometry of bone marrow aspiration, the only finding was increased eosinophil level. Abdominal and thoracic a computerized tomography (CT) scans showed an increased size of para-aortic lymph nodes. On her examination, lymphadenopathy was present in the inguinal region. Therefore, a biopsy of an inguinal lymph node was performed to rule out lymphoma. Lymph node biopsy was negative for lymphoma. Fasciola serology was performed for the patient, and the stool exam was collected three times (for one day in between) to rule out parasitic disease, including Fasciola, etc. Due to weakly positive serology Fasciola hepatica, triclabendazole was started for the patient (it was given in two doses, 12 hours apart), despite the absence of Fasciola parasitic eggs in her stool. During hospitalization, the patient’s fever was stopped and by starting the use of mentioned drug, eosinophilia was reduced. The patient received a complete improvement in the follow-up. Conclusion: In patients with hypereosinophilia, parasitic diseases such as fascioliasis should be considered even if the fecal specimen is negative for Fasciola eggs.