TRICHINOSIS: REPORT OF CASE MANIFESTING MYOCARDITIS, ENCEPHALITIS AND RADIAL NEURITIS; RESPONSE TO ACTH; REVIEW OF LITERATURE REGARDING THE ERYTHROCYTE SEDIMENTATION RATE

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Abstract
An isolated case of heavy infestation of Trichinella spiralis rapidly responded in 3 crises to intraven. ACTH therapy. Intramusc. ACTH was not efficacious. The encephalitis presented a Korsakoff syndrome; psychologic testing during convalescence pointed towards probable permanent structural damage of the higher function centers. Ecg. evidence of myocarditis during the acute stage was noted and at 6 mos. ballistocardiographic studies were interpreted as being abnormal as a sequela of myocarditis in a 34-year old. Thus therapy, although considered life-saving, when instituted an estimated 3 weeks after onset of illness, did not prevent permanent derangement. The erythrocyte sedimentation rate (ESR) remained normal at first when illness was at its height. It was postulated that the anaphylactic nature of the disease in its early stages might best explain this finding. Analysis of the literature indicated that in uncomplicated trichinosis a relatively normal ESR was comparable in incidence to that of eosinophilia ( > 6%). In 4 fatal cases, the ESR finding was sole hematologic testimony as to the nature of the illness. Low blood fibrinogen levels may explain the ESR retardation; such determinations are yet to be recorded in this disease.