A 58-Year-Old Woman with Fatigue, Abdominal Bloating, and Eosinophilia
Abstract
A 58-year-old woman was evaluated at Massachusetts General Hospital for fatigue, abdominal bloating, and eosinophilia following recent travel to the Democratic Republic of Congo, where she had sustained a traumatic leg injury and was exposed to freshwater and insect bites. Laboratory investigations showed persistent moderate eosinophilia over 8 months and elevated Epstein-Barr virus antibody titers. CT imaging revealed calcified lesions in the lung, liver, spleen, and lymph nodes suggestive of granulomatous disease. Infectious disease evaluation considered helminthic infections, including filarial diseases. Blood smear microscopy and PCR confirmed Mansonella perstans infection. Treatment included doxycycline for six weeks with peri-doxycycline ivermectin dosing. Fatigue improved, eosinophilia diminished, and follow-up is ongoing. The case reviews differential diagnoses, diagnostic methods for filariasis, and the therapeutic role of doxycycline targeting Wolbachia endosymbionts