Chronic polyarthritis as isolated manifestation of toxocariasis

Abstract

Human toxocariasis is a parasitic zoonosis mainly caused by Toxocara canis or Toxocara cati and is acquired by ingestion of the parasite's embryonated eggs. Arthralgia and/or arthritis were reported in up to 17% of the cases, generally with acute duration (less than 6 weeks). However, to our knowledge, chronic polyarthritis, as the isolated presentation of Toxocara infection, was not reported. One of the 5809 patients that was followed up at our service (0.017%) had chronic polyarthritis as the single manifestation of toxocariasis and was described herein. A 3-year-old girl was referred to our service with severe painful chronic polyarthritis for a period longer than 10 weeks and morning stiffness of 30min. Dog contact exposure history in the recreational areas of neighborhood was reported. Her exams showed high levels of eosinophils in peripheral blood (29%), bone marrow aspirate revealed marked eosinophilia (32%) and Toxocara enzyme-linked immunosorbent assay (Elisa) was positive (1:1280). She was treated with paracetamol (40mg/kg/day) and thiabendazole (25mg/kg/day) for 10 days, and all manifestations reduced. After eight months of follow-up, she was on clinical and laboratorial remission. In conclusion, we described a case of chronic polyarthritis, as isolated manifestation of toxocariasis, mimicking juvenile idiopathic arthritis and leukemia. Importantly, this zoonosis should be considered in patients with arthritis and eosinophilia.

Human Toxocariasis: 2010 to 2020 Contributions from Brazilian Researchers

“…Acute joint manifestations are common in toxocariasis; however, chronic polyarthritis as an isolated manifestation is very uncommon. Viola et al 62 reported the case of a 3-year-old girl with chronic severe, painful polyarthritis and 30 min of morning stiffness that lasted longer than 10 weeks. The patient was positive for anti- Toxocara antibodies on ELISA.…”

Toxocariasis in Children: An Update on Clinical Manifestations, Diagnosis, and Treatment

“…21 The cutaneous manifestations of human toxocariasis include chronic prurigo, pruritus, urticaria, eczema, and vasculitis. 22 Other less common manifestations include nephrotic syndrome, 23 arthritis, 24 and myocarditis. 25 Heart tissue damage is caused by the enzyme peroxidase released from infiltrated eosinophils, regardless of the presence or absence of larvae.…”