Egiroh Omene (PGY5 neurology resident)1, Dr. Joseph Blondeau2a, Dr. Stephen Sanche2a & 3a, Satchan
Takaya3a, Shravankumar Nosib3b, Rim Zayed5, Nnamdi Ndubuka5, Emily Jenkins4, Pratap Kafle4, Vladislav Lobanov,
Departments of Neurology1, Pathology and Laboratory Medicine (Microbiology Division2a and Anatomical
Pathology Division2b), Department of Medicine (Infection Disease Division3a and Cardiology 3b), Department of Veterinary
Microbiology4, University of Saskatchewan, Northern Population Health Unit5, Saskatchewan Health Authority, Canada.
24 year old female presented with two week history of acute onset of muscle aches, nausea, vomiting and diarrhea. A week prior to becoming symptomatic, herself and her family consumed some meet outdoor.
Her laboratory work includes elevated white blood count, eosinophilia, increased ESR, CRP, troponin, CK (2165 U/L), and LDH, and mildly elevated LFTs. ECG revealed sinus tachycardia. Cardiac MRI was normal. Antibody panel for inflammatory and necrotizing myopathies came back negative. Anti-mitochondrial antibodies were also negative. Serology for Leptospira was negative. Serology for other parasites was not convincing. Ova and parasites were not seen in stool specimen. Biopsy of right quadriceps was performed.
1 : Possible differential diagnosis after reviewing low power H&E stain?
2 : Final diagnosis after reviewing high power H&E stain and electron microscopy?
3 : Would negative or borderline serology preclude from the correct diagnosis and treatment?
4 : Role of molecular testing in this type of muscle disorders?
Case of Trichinella Nativa muscle infestation