A 38-year-old Japanese male who had traveled in China from September 13 to October 5, 1997, developed fever and severe conjunctivitis from October 20. After he was hospitalized in Kyoto CityHospital for persistent high fever on October 29, he developed muscular weakness and dysphagiawhich continued for two weeks. An electromyogram showed a myogenic pattern, and laboratoryfindings showed significant elevation of serum enzyme levels of muscle origin: CPK, 3, 095 IU/l; aldorase, 195 IU/l; myoglobin, 7, 570 ng/ml, and myoglobinuria, 94, 700 ng/ml. The WBC was 10, 800/111with 45% eosinophils. Muscular biopsy showed degeneration of muscle fibers with infiltration ofmacrophages and lymphocytes.
On further inquiry, it was revealed that the patient had eaten smoked bear meat in China onSeptember 30, three weeks prior to the onset of symptoms. A dot-ELISA serologic test for parasiteswas positive forTrichinella. Further, a coiled 1.2 mm longTrichinellalarve was recovered from approximately100 mg of frozen biopsied muscle by an enzyme digestion method. Mebendazole wasgiven to the patient at a dosage of 200 mg/day for seven days. CPK levels were normalized within 3days of the beginning of the treatment, and he was discharged without any symptoms. Physiciansmust be aware of trichinellosis and should include it in their differential diagnosis when examiningpatients with myositis and eosinophilia of unknown origin.