Systemic Toxocariasis Presenting With Eosinophilic Ascites and Pericardial Effusion = Systemic Toxocariasis Presenting With Eosinophilic Ascites and Pericardial Effusion

다국어 초록 (Multilingual Abstract)

Visceral larva migrans (VLM) syndrome is a clinical manifestation of systemic organ involvement by Toxocara species. It is often asymptomatic and self-limiting while some present various manifestations. Here we report a case of a 48-year-old male patient admitted for abdominal distension and chest discomfort. Initial blood tests showed hemoglobin of 13.1 g/dL, hematocrit 38.7%, 14,290 leukocytes with 55.3% eosinophils, 155,000/mm3 platelets, mildly increased AST 67 IU/mL and ALT 216 IU/mL, serum total protein 5.9 g/dL, albumin 3.6 g/dL, and proBNP 1,674.2 pg/mL. The antinuclear antibody (ANA), anti-mitochondrial antibody (AMA), anti-smooth muscle antibody were all negative. Abdominal CT (Fig. A) and ultrasonography(Fig. B) revealed moderate amount of ascites and both pleural effusion. Echocardiography showed scanty pericardial effusion with preserved ejection function (Fig. C). The ascitic fluid was clear and straw-colored, which cell count showed 4,500 cells/mm3 with 90% eosinophils, indicating eosinophilic ascites. We considered eosinophilic gastroenteritis and parasitic infestation for differential diagnosis. Total IgE was 189.9 IU/mL and serology results were positive for toxocariasis Ab IgG. The diagnosis of active systemic toxocariasis was made and albendazole 800 mg was initiated. 2 months later, follow-up CT revealed no apparent ascites, pleural effusion and pericardial effusion (Fig. D). We report this case as systemic involvement of toxocariasis may delay the diagnosis as serologic testing is not routinely performed at clinical settings.