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37 THE ANTISEPTIC Vol. 115 January 2018 CASE REPORT Introduction Toxocariasis, caused by infection with larvae of Toxocara canis, manifests in humans in a range of clinical syndromes like : visceral and ocular larva migrans, neurotoxocariasis and covert or common toxocariasis. Toxocara canis is one of the most widespread zoonotic parasitic infections humans share with dogs, cats and wild canids, particularly foxes. Human infection occurs by the accidental ingestion of embryonated eggs or larvae. Most infections are asymptomatic. Clinically overt infections are difficult to diagnose as serological confirmatory tests are expensive and not easily available. 1 The present case highlights hepatic toxocariasis in an immunocompetent host which resolved with treatment. Case report A 32 year old male presented with high grade fever with chills and rigors, right upper abdominal pain, and yellowish discoloration of eyes for one week. He had two pet dogs and one cat. Ultrasound of the abdomen showed hepatomegaly with multiple hypoechoic lesions in both lobes of liver. Amoebic serology, hydatid serology, HIV serology and blood cultures were negative. Computed tomography scan (Panel a) and magnetic resonance imaging (Panel b) Liver involvement in visceral larva migrans MAYANK JAIN Dr. Mayank Jain Consultant Gastroenterologist Gleneagles Global Health City, Chennai-600 100 Specially Contributed to "The Antiseptic" Vol. 115 No. 1 & P : 37 - 37 ABSTRACT Toxocara canis is one of the most widespread zoonotic parasitic infections. Human infection occurs by the accidental ingestion of embryonated eggs or larvae .The present case highlights hepatic toxocariasis in an immunocompetent host which presented as fever and jaundice. The infection resolved with appropriate treatment. showed multiple conglomerated complex ovoid lesions (2-8cms) in both lobes of liver. In view of clinical history,liver biopsy showing eosinophilic granulomas and elevated Ig E levels (975 IU/ml), possibility of hepatic toxocariasis was considered. The patient was treated with albendazole 400 mg twice a day for 5 days.He responded clinically and had resolution of lesions within 4 weeks. (Panel C) Discussion Toxocariasis results in eosinophilic inflammation causing eosinophilic abscess or granuloma in the liver and lungs. Due to migratory nature of the lesions, the disease is called as visceral larva migrans. Toxocariasis of the liver presents as multiple liver lesions that are usually mistaken for other conditions 2 On imaging, hepatic lesions are seen as multiple, ill- defined, oval lesions that measure 1.0-1.5 cm in diameter and are best appreciated in the portal venous phase of contrast- enhanced CT and MR imaging. Differential diagnoses include liver metastasis, hepato cellular carcinoma and granulomatosis of the liver 3 . In the absence of risk factors like geophagia, pet dogs etc and atypical presentations, liver needle biopsy and histological examination could be necessary 4 . REFERENCES 1. Macpherson CN. The epidemiology and public health importance of toxocariasis: a zoonosis of global importance. Int J Parasitol. 2013; 43: 999–1008 2. Leone N, Baronio M, Todros L, David E, Brunello F, et al. Hepatic involvement in larva migrans of Toxocaracanis: report of a case with pathological and radiological findings. Dig Liver Dis.2006; 38: 511- 514. 3. Lim JH .Toxocariasis of the liver: visceral larva migrans. Abdom Imaging 2008; 33: 151-156. 4. Azuma K, Yashiro N, Kinoshita T, Yoshigi J, Ihara N .Hepatic involvement of visceral larva migrans due to Toxocaracanis: a case report--CT and MR findings. Radiat Med 2002;20: 89-92. Panel A Panel B Panel C

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37 THE ANTISEPTIC Vol. 115 • January 2018

Case RepoRt

Introduction

Toxocariasis, caused by infection with larvae of Toxocara canis, manifests in humans in a range of clinical syndromes like : visceral and ocular larva migrans, neurotoxocariasis and covert or common toxocariasis. Toxocara canis is one of the most widespread zoonotic parasitic infections humans share with dogs, cats and wild canids, particularly foxes. Human infection occurs by the accidental ingestion of embryonated eggs or larvae. Most infections are asymptomatic. Clinically overt infections are difficult to diagnose as serological confirmatory tests are expensive and not easily available.1

The present case highlights hepatic toxocariasis in an immunocompetent host which resolved with treatment.Case report

A 32 year old male presented with high grade fever with chills and rigors, right upper abdominal pain, and yellowish discoloration of eyes for one week. He had two pet dogs and one cat. Ultrasound of the abdomen showed hepatomegaly with multiple hypoechoic lesions in both lobes of liver. Amoebic serology, hydatid serology, HIV serology and blood cultures were negative. Computed tomography scan (Panel a) and magnetic resonance imaging (Panel b)

Liver involvement in visceral larva migransMayank Jain

Dr. Mayank JainConsultant GastroenterologistGleneagles Global Health City, Chennai-600 100

Specially Contributed to "The Antiseptic" Vol. 115 No. 1 & P : 37 - 37

abstRaCt

Toxocara canis is one of the most widespread zoonotic parasitic infections. Human infection occurs by the accidental ingestion of embryonated eggs or larvae .The present case highlights hepatic toxocariasis in an immunocompetent host which presented as fever and jaundice. The infection resolved with appropriate treatment.

showed multiple conglomerated complex ovoid lesions (2-8cms) in both lobes of liver. In view of clinical history,liver biopsy showing eosinophilic granulomas and elevated Ig E levels (975 IU/ml), possibility of hepatic toxocariasis was considered. The patient was treated with albendazole 400 mg twice a day for 5 days.He responded clinically and had resolution of lesions within 4 weeks. (Panel C)Discussion

Toxocariasis results in eosinophilic inflammation causing eosinophilic abscess or granuloma in the liver and lungs. Due to migratory nature of the lesions, the disease is called as visceral larva migrans. Toxocariasis of the liver presents as multiple liver lesions that are usually mistaken for other conditions2 On imaging, hepatic lesions are seen as multiple, ill-defined, oval lesions that measure 1.0-1.5 cm in diameter and are best appreciated in the portal venous phase of contrast-

enhanced CT and MR imaging. Differential diagnoses include liver metastasis, hepato cellular carcinoma and granulomatosis of the liver3. In the absence of risk factors like geophagia, pet dogs etc and atypical presentations, liver needle biopsy and histological examination could be necessary4.RefeRenCes1. Macpherson CN. The epidemiology and public health

importance of toxocariasis: a zoonosis of global importance. Int J Parasitol. 2013; 43: 999–1008

2. Leone N, Baronio M, Todros L, David E, Brunello F, et al. Hepatic involvement in larva migrans of Toxocaracanis: report of a case with pathological and radiological findings. Dig Liver Dis.2006; 38: 511- 514.

3. Lim JH .Toxocariasis of the liver: visceral larva migrans. Abdom Imaging 2008; 33: 151-156.

4. Azuma K, Yashiro N, Kinoshita T, Yoshigi J, Ihara N .Hepatic involvement of visceral larva migrans due to Toxocaracanis: a case report--CT and MR findings. Radiat Med 2002;20: 89-92.

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