CREEPING ERUPTION DUE TO LARVAE OF THE SUBORDER SPIRURINA—A NEWLY RECOGNIZED CAUSATIVE PARASITE

Case 1: A 47-year-old businessman was referred to Mie University Hospital on April 3, 1990, for the evaluation of itchy eruptions on the abdomen of 5 days' duration. He had not eaten freshwater-fish or raw sea-fish in the last few months. He did not have family members with similar eruptions. On examination, there was a linear erythema measuring 5 cm, with a small loop and a rice-sized papule on the right side of the navel. Eosinophil counts were in the normal range (WBC: 4700/mL; eosinophils; 1.3%). Serum IgE level was also in the normal range (21 U/mL). Biopsies were obtained from the papule and the inner end of the linear erythema, sites that were thought to include parasites; however, the patient noticed itchy sensations on the opposite side of the biopsies on the next day and recognized new eruptions 2 days later. When he visited our hospital again on April 7, there were new papules and linear lesions with pustules on the right side of the abdomen (Fig. 1). A spindle-shaped biopsy of 1 cm width was taken from the pustule with surrounding normal appearing skin. No further eruptions appeared after the surgical removal of the pustule. The section stained with hematoxylen and eosin contained only a pustule with eosinophils and neutrophils in the epidermis and many eosinophils and neutrophils in the upper dermis (Fig. 2). The serum antibody against Gnathostoma was not detected by the Ouchterlony method or immunoblot analysis. The patient's serum reacted positively with the section of suborder Spirurina (Fig. 3), but not with the section of Gnathostoma tiispidum by indirect immunofluorescence, including antihuman IgG labeled with FITC (Cappel, USA). In addition, normal control sera and the sera from the patients of human gnathostomiasis did not react with the sections of suborder Spirurina using the same methods.