Hymenolepis Nana Infection in a 6-Year Old Child with Uncommon Manifestations: A Case Report

Hymenolepis is a comman parasitism disease in the developing countries that usually is manifested with nonspecific symptoms and this desease diagnoses accidently. In this case report, a 6 year old boy sufferd from fever, tremor, meningismus, weight loss and abdominal pain has been described. Case Report: He had experienced a weight loss of about 5 kg and reported a periodic fever predominantly at nights for 2-3 months. Primary tests including, CBC, Urine analysis, Stool examination(S/E) and LP were normal. Clinical examination showed three mobile submandibular lymph nodes with maximum size of 1×1 cm. A solid and tender epigastric mass extended to the umbilical region was also detected. The abdomen was soft with no organomegaly. Abdominal sonography confirmed the presence of a hang mass 66 x 25mm in size, located between aorta and superior mesenteric artery in epigastric region causing a space between aorta and superior mesenteric artery was detected. CT-Scan showed mesenteric lymph nodes as multiple and integrated masses. The report of MRI, performed to exclude brain metastase and the MRI was normal. In bone marrow aspiration and biopsy, megakaryocytes and hypereosinophilia and an increase of PMN were detected. Since the signs and symptoms including headache and lethargy continued, an explorative and therapeutic laparatomy was conducted. The second stool exam after operation was positive for H.Nana eggs. Liver biopsy showed an eosinophilia. The patient was treated with niclosamide. The patient's clinical presentation improved four days after treatment with no changes in the size of mass prednisolon was added to niclosamide. The mass was reduced 10 days after treatment and S/E turned to negative for H.nana egg. The patient was discharged and after month, there was no sign of the mass in abdominal sonography. The patient completely recoverd in the next year but the serology test of H.nana remained positive. In conclusion, in the light of this case the results of other similar studies, we suggest that H. nana be included among the intestinal parasites to be investigated in newly arrived children from low hygiene areas. Because H.nana infections may presrnt with unusual and nonspecific manifestations.