Lorenzo Volpicelli1, Maurizio De Angelis2, Alessandra Morano3, Elisa Biliotti4, Cristiana Franchi5, Simona Gabrielli6, Simonetta Mattiucci7, Carlo Di Bonaventura8, Gloria Taliani9. 1. Hepatology Unit, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. Electronic address: lorenzo.volpicelli@uniroma1.it. 2. Hepatology Unit, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. Electronic address: mauriziodeangelis@yahoo.com. 3. Epilepsy Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy. Electronic address: alessandra.morano@hotmail.it. 4. Hepatology Unit, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. Electronic address: elisa.biliotti@uniroma1.it. 5. Hepatology Unit, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. Electronic address: cristiana.franchi@gmail.com. 6. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. Electronic address: simona.gabrielli@uniroma1.it. 7. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. Electronic address: simonetta.mattiucci@uniroma1.it. 8. Epilepsy Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy. Electronic address: c_dibonaventura@yahoo.it. 9. Hepatology Unit, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy. Electronic address: gloria.taliani@uniroma1.it.
Abstract
BACKGROUND: Loiasis is a vector-borne parasitic infection endemic across many areas of Central and West Africa. Its treatment is tricky due to the risk of serious neurologic adverse events occurring after the administration of microfilaricidal drugs, like diethylcarbamazine or ivermectin, in subjects with high pre-treatment microfilarial load. Albendazole is currently recommended to slowly reduce microfilaremia before curative regimen is prescribed. CASE PRESENTATION: We report the case of a 25-year-old man from Guinea-Conakry who was incidentally diagnosed with highly microfilaremic Loa loa infection. A three weeks regimen of albendazole was prescribed. Minor neurologic side effects occurred after two weeks of administration, while serious encephalopathy developed one week later. Clinical and electroencephalographic features of the patient resembled those of an immune-mediated encephalitis. After exclusion of other causes of encephalopathy, treatment-related Loa loa encephalopathy induced by albendazole was suspected. Corticosteroid treatment was administered and the patient recovered. DISCUSSION: Our case confirms that Loa loa treatment-related encephalopathy may occur even during albendazole treatment. The clinical and electroencephalographic similarities between Loa loa albendazole-related encephalopathy and immune-mediated encephalitis suggest the possibility of an underlying inflammation-based pathogenesis. Although corticosteroid administration is not recommended in Loa loa ivermectin-induced encephalopathy, in this case of Loa loa albendazole-induced encephalopathy it may have played a therapeutic role.
BACKGROUND:Loiasis is a vector-borne parasitic infection endemic across many areas of Central and West Africa. Its treatment is tricky due to the risk of serious neurologic adverse events occurring after the administration of microfilaricidal drugs, like diethylcarbamazine or ivermectin, in subjects with high pre-treatment microfilarial load. Albendazole is currently recommended to slowly reduce microfilaremia before curative regimen is prescribed. CASE PRESENTATION: We report the case of a 25-year-old man from Guinea-Conakry who was incidentally diagnosed with highly microfilaremic Loa loa infection. A three weeks regimen of albendazole was prescribed. Minor neurologic side effects occurred after two weeks of administration, while serious encephalopathy developed one week later. Clinical and electroencephalographic features of the patient resembled those of an immune-mediated encephalitis. After exclusion of other causes of encephalopathy, treatment-related Loa loaencephalopathy induced by albendazole was suspected. Corticosteroid treatment was administered and the patient recovered. DISCUSSION: Our case confirms that Loa loa treatment-related encephalopathy may occur even during albendazole treatment. The clinical and electroencephalographic similarities between Loa loaalbendazole-related encephalopathy and immune-mediated encephalitis suggest the possibility of an underlying inflammation-based pathogenesis. Although corticosteroid administration is not recommended in Loa loaivermectin-induced encephalopathy, in this case of Loa loaalbendazole-induced encephalopathy it may have played a therapeutic role.
Authors: Elisabetta Pallara; Sergio Cotugno; Giacomo Guido; Elda De Vita; Aurelia Ricciardi; Valentina Totaro; Michele Camporeale; Luisa Frallonardo; Roberta Novara; Gianfranco G Panico; Pasquale Puzo; Giovanni Alessio; Sara Sablone; Michele Mariani; Giuseppina De Iaco; Eugenio Milano; Davide F Bavaro; Rossana Lattanzio; Giulia Patti; Roberta Papagni; Carmen Pellegrino; Annalisa Saracino; Francesco Di Gennaro Journal: Am J Trop Med Hyg Date: 2022-08-01 Impact factor: 3.707