Sunday, October 05, 2008

Clam Digger's Legs

Mike LaCombe, a cardiologist from Maine, has a question for our panel.

"G.M. is a 48 y.o. clam digger from Maine. These individuals are exposed to avian schistosomiasis, and on a web search, the consequent clam-digger’s itch has been rarely associated with lymphedema.

Sorry, I have no pictures. This man has well-documented lymphedema of the lower extremities for six months.

All studies negative: CT scans of pelvis, abdomen, chest, ultrasound of leg veins, cardiac echo ruling out any cor pulmonale, and labs showing no evidence of liver disease, hypoalbuminemia.

My questions are:
1. Does anyone have any experience with this?
2. Any specific tests to confirm the diagnosis?
3. Therapy suggestions?
"

There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy." Always something new.

4 comments:

  1. Hamish DunwoodieOctober 05, 2008

    This is an interesting case. We have seen an occasional similar patient in NB.
    My impression is that the bird schistosomes and the chronic maceration may have caused low grade cellulitis with resultant venous and lymphatic obstruction. I am not sure that can be distinguished from schistosomal lymphedema. There may be some serologic test that would help.

    From the treatment standpoint, I'd recommend lymphatic massage, support stockings, systemic antibiotics when necessary and topical steroids if there is inflammation.

    The following article has some treatment guidelines: Recurrent cellulitis after saphenous venectomy for coronary bypass surgery.
    Baddour LM, Bisno AL.
    Ann Intern Med. 1982 Oct;97(4):493-6.

    Good luck with your patient.
    Hamish, Moncton, NB

    ReplyDelete
  2. Dr. RiemannOctober 05, 2008

    Now, that's an interesting case! I would do urine and stool for eggs and, if that is negative, would try to obtain a schistosoma mansoni adult microsomal antigen ELISA or a schistosoma immunoblot.

    Helge Riemann

    ReplyDelete
  3. Hi
    I hope its not filariasis, that would be common in india.Microfilaria in blood could be looked for.
    Dr Manish Pahwa
    MD DNB

    ReplyDelete
  4. nice case, i just want to ask whether u have done his thyroid function tests,just have a check on them & let it be known

    ReplyDelete

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