Acute Fulminant Granulomatosis Infection in an Immunocompetent Person: Case Report

Document Type : Case Report

Authors

1 َAssistan Professor, Department of Infectious Diseases and Tropical Medicine, School of Medicine AND Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of Infectious Diseases and Tropical Medicine, School of Medicine AND Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Resident, Department of Internal Medicine, School of Medicine, Yasouj University of Medical Sciences, Yasouj, Iran

4 Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Balantidiasis is a disease can be manifested with acute clinical presentations which mimic lymphoma. In this article, we have been reported balantidiasis in a young immunocompetent person suspicious to lymphoma. This may be the first reported case of balantidiasis in an immunocompetent person in Iran.Case Report: In an 18-years-old man, the disease was initiated with abdominal pain and weight loss. His abdominal pain was associated with fever, chills, dysentery and tenesmus. Bone marrow aspiration and biopsy was done with suspicion to lymphoma. There was not any presentation of malignancy in his aspiration and biopsy. With these findings, he became candidate for diagnostic laparatomy and biopsy of affected tissues. Balantidiasis was considered according to the pathologic report of parasitic granulomatosis infection and his dramatic response to doxycycline.Conclusion: This case, and the same, previously reported cases, suggest that parasitic granulomatosis infection-like balantidiasis should be considered as other differential diagnosis particularly in patients with complaint of fever, hepatosplenomegaly, weight loss and lymphadenopathy.

Keywords


  1. Solaymani-Mohammadi S, Mobedi I, Rezaian M, Massoud J, Mohebali M, Hooshyar H, et al. Helminth parasites of the wild boar, Sus scrofa, in Luristan province, western Iran and their public health significance. J Helminthol 2003; 77(3): 263-7.
  2. Solaymani-Mohammadi S, Rezaian M, Hooshyar H, Mowlavi GR, Babaei Z, Anwar MA. Intestinal protozoa in wild boars (Sus scrofa) in western Iran. J Wildl Dis 2004; 40(4): 801-3.
  3. McCarey AG. Balantidiasis in South Persia. Br Med J 1952; 1(4759): 629-31.
  4. Ladas SD, Savva S, Frydas A, Kaloviduris A, Hatzioannou J, Raptis S. Invasive balantidiasis presented as chronic colitis and lung involvement. Dig Dis Sci 1989; 34(10): 1621-3.
  5. Jalayer T, Kavianpor M, Alizadeh A, Faryd-Moayer H. A report of two cases of human balantidiasis in Bandar- Abbas and Bandar– Jask, Southern Iran. Proceedings of the 3rd National Congress on Tropical Medicine and Infectious Diseases; 1988 Oct 1-4; Isfahan, Iran; Isfahan University Press. p.61.
  6. Sanati A, Sheiban F, Ghadirian S. Prevalence of balantidiasis in Iran. Tehran Univ Med J 1971; 29(5): 183-4.
  7. Maleky F. Case report of Balantidium coli in human from south of Tehran, Iran. Indian J Med Sci 1998; 52(5): 201-2.
  8. Cho HS, Shin SS, Park NY. Balantidiasis in the gastric lymph nodes of Barbary sheep (Ammotragus lervia): an incidental finding. J Vet Sci 2006; 7(2): 207-9.
  9. Arean VM, Koppisch E. Balantidiasis; a review and report of cases. Am J Pathol 1956; 32(6): 1089-115.