Myiasis Due to Hypoderma lineatum Infection Mimicking the Hypereosinophilic Syndrome  John Starr, MD, John H. Pruett, PhD, John W. Yunginger, MD, Gerald J. Gleich, MD  Mayo Clinic Proceedings  Volume 75, Issue 7, Pages 755-759 (July 2000) DOI: 10.4065/75.7.755 Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Second instar stage of Hypoderma lineatum. The white larva was about 1 cm long and 0.15 cm in diameter. It emerged from the patient's skin on December 18, 1995. Morphologic identification was based on distinctive features in the spircular plate (the breathing apparatus on the posterior end) to distinguish between the species and larval stage. Mayo Clinic Proceedings 2000 75, 755-759DOI: (10.4065/75.7.755) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Immunofluorescent localization of eosinophil granule major basic protein (MBP) in surgical muscle biopsy specimens (A and C). Sections were stained with affinity-purified rabbit antihuman MBP (B and D). Hematoxylin-eosin (H&E) counterstains of the same areas are shown in A and C, respectively. Extensive extracellular MBP deposition was present between muscle bundles (A); however, intact eosinophils were not evident on the H&E counterstain of the same area (B). In another area from the same biopsy specimen, striking extracellular MBP deposition was also noted in disrupted fascia (C); few eosinophils were observed in the H&E counterstain of the same area (D). (A-D, original magnification, ×400.) Mayo Clinic Proceedings 2000 75, 755-759DOI: (10.4065/75.7.755) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 3 Sodium dodecyl sulfate polyacrylamide gel electrophoresis and Western blot analyses of extract of Hypoderma lineatum first instar larvae (HL1) and patient's serum. A, The 12% polyacrylamide gel shows marker proteins in the left and right lanes with molecular mass listed in kd; 50 μg of HL1 was applied to the gel, and the gel was stained with Coomassie blue. B, After Western blotting and exposure to the patient's serum, the membrane was developed with radiolabeled anti-IgE; exposure time was 5 hours. C, After Western blotting and exposure to the patient's serum, the membrane was developed with radiolabeled staphylococcal protein A. The immunoblot was exposed for 45 minutes. In blots made with serum from a normal nonexposed individual, only faint staining of 3 bands appeared after 16 hours (results not shown). Mayo Clinic Proceedings 2000 75, 755-759DOI: (10.4065/75.7.755) Copyright © 2000 Mayo Foundation for Medical Education and Research Terms and Conditions