Trematode induced conjunctival granuloma- Case report

A 10 year old boy presented with complaints of itching, redness and swelling in his left eye for 10 days. History revealed his habit of swimming in his village pond everyday. Ocular examination revealed a visual acuity of 6 by 6 in both his eyes. Slit lamp examination of cornea, anterior segment, lens and posterior segment in his right eye was normal. Examination of the left eye revealed a firm globular subconjunctival nodule at the temporal bulbar conjunctiva. A few large mutton fat keratic precipitates and anterior chamber reaction including both cells and flare were present. Posterior segment examination of his left eye was normal. Routine blood investigations were normal except for a mild increase in oesinophils. X ray chest was also done to rule out tuberculosis and sarcoidosis. Serologic tests for syphilis and skin test with purified protein derivative were negative. Surgical excision of nodule was done and treated with topical steroids. Conjunctival and anterior segment inflammation subsided. Histologic analysis of the nodule revealed a tegument andor the internal structures of a trematode surrounded by a zonal granulomatous inflammation. Molecular studies for species identification, proved to be procerovum species