Presumptive Gnathostoma binucleatum-infection in a Belgian traveler returning from South America.

Gnathostomiasis, caused by third stage larvae of Gnathostoma spp., a zoonotic nematode found in tropical and subtropical regions is an emerging parasitic infection in humans. Once thought to be confined to South East Asia, increasing numbers of cases originating in other regions are being described, both in autochthonous populations and travelers. Gnathostomiasis usually presents with cutaneous manifestations and eosinophilia, appearing weeks to months after consuming raw fish. Visceral and central nervous system involvement may occur, causing substantial morbidity. Although eosinophilia provides a clue to diagnosis, it may be absent in up to 55% of the cases. We describe a case of cutaneous gnathostomiasis in a Belgian traveler returning from South America, with no evident exposure and no blood eosinophilia, finally diagnosed by surgical resection and histological examination of the causative larva.