(BMJ)—A woman in her 50s presented with a rash in addition to fever, malaise, and abdominal and muscle pain. She had eaten bear, lamb, and deer meat at a restaurant 2 weeks prior. Exam: diffuse maculopapular rash. Labs: eosinophilia. What’s the dx?
Leptospirosis
Avian influenza
Trichinellosis
Alpha-gal syndrome
Typhoid fever
You are correct. Serology was positive for antibodies to Trichinella spiralis. T. spiralis is a nematode parasite that causes trichinellosis. Eating raw or undercooked infected pig, horse, boar, or deer meat typically causes GI sx. Cutaneous manifestations are rare. T. spiralis is particularly resistant to freezing and will only be destroyed if meat is well cooked. Ask about consumption of game meat and request serological tests for trichinellosis when a patient has prolonged eosinophilia with muscle pain and abdominal sx, with or without a maculopapular rash.

BMJ 2021;372:n508