Dear Editor,
we read with great interest the article recently published by Morishima
L et al. (1 ). The Authors report an high incidence of
Anisakis-specific IgE antiboides in patients with anaphylaxis in two
towns in Japan.Worlwide the incidence of Anisakis patients is related to
the ingestion of raw fish in seaside places. Herein we present the case
of a child who has experienced an anaphylaxis with acute respiratory
symptoms and a strange scrotal mass, in Calabria, a region completely
surrounded by the sea in Southern Italy.
An 8-year-old child italian child referred to our Emergency Department
with a clinical complaint characterized by acute respiratory distress
and right testicular pain since almost 24 hours, that worsened during
the day. The respiratory picture resolved almost immediately with the
use of corticosteroids via i.v. The clinical examination showed the
presence of a painful testicle-independent swelling of about 1 cm in
diameter, between the perineal plane and the scrotum, in the absence of
signs of inflammation.
The doppler ultrasonography demonstrated the presence of phlogistic area
at the level of the right epididymis. We decide for home observation and
medical therapy (betamethasone and amoxy-clavulanic acid) with mild
improvement in symptoms in the following 3 days.
After 4 days the child came back to our attention with an important
scrotal lymphadenitis consensual to the previous epididymitis, with
erythematous and warm scrotal skin. The intense scrotal pain, as in a
clinical picture of acute scrotum, did not allow to visit the boy
correctly.
A second US showed an independent mass from the testicle of about 1 cm.
The laboratory findings were completely negative, including testicular
markers for tumour.
The formula was; white blood cells 5.800, Neutrophiles 48.9%,
Lymphocytes 41.8%, Eosinophils 0.8%. At surgical exploration the
testicle was normal and a paratesticular granulomatous mass of about 2
cm in diameter was removed.
The section of the anatomical specimen in the operatory room left us
speechless.
Inside the operating specimen we found … Worms! The histological
examination confirmed a case of extra-gastrointestinal anisakiasis.