Eosinophilic Myocarditis Associated with Visceral Larva Migrans Caused byToxocara CanisInfection

Abstract

A 41-year-old woman who was diagnosed with myocarditis presented eosinophilia. Since the antibody against Toxocara canis (T. canis) was positive, we diagnosed that she had visceral larva migrans due to T. canis associated with myocarditis. She was treated with oral albendazole and prednisolone for two weeks, eosinophil count and hepatic enzymes were normalized after completion of treatment. This is the first report of myocarditis caused by T. canis infection in Korea.

Cardiac Manifestations of Toxocariasis: A Case Report of Loffler Endocarditis and Literature Review

“…However, in view of the patient's biological history, he was probably infected a long time ago without any particular symptoms and his heart damage could be more recent causing a significant increase in the eosinophil count, leading to hospitalization. Of the 18 reported cases of toxocariasis with cardiac manifestations [3][4][5], with the exception of three asymptomatic cases discovered incidentally (surgery and hypereosinophilia), patients first suffered from dyspnea (nine patients), thoracic pain (five patients), edema (three patients), and extracardiac symptoms of digestive origin (two cases of abdominal pain, one case of diarrhea, and one case of hepatomegaly) or cutaneous origin (three cases of hives and in our case, purpura). Death occurred in two children with myocarditis [11].…”

“…Three stages are commonly described during eosinophil invasion: acute necrotizing phase, thrombotic phase, and at the end of the disease, endomyocardial fibrosis phase. Globally, toxocariasis is not easily diagnosed until the final pathological stage [3,12].…”

“…Among the reported cases, therapeutic attitudes differed greatly: six patients were treated with a combination of corticosteroids and antiparasitic drugs such as albendazole, two were treated with corticosteroids only, three were treated with antiparasite drugs only, five were given symptomatic treatment, two patients were not treated, and treatment was not specified in two patients [3][4][5]. Treatment is unnecessary for asymptomatic persons; otherwise, combined therapy using corticosteroids and antiparasitic drugs such as albendazole is more frequently used.…”

“…In the literature, 18 observations of cardiac toxocariasis have been reported including 11 cases of myocarditis, three cases of tamponades, three cases of Löffler fibroblastic endocarditis, and one case of myopericarditis [3][4][5]. This paper describes a fourth case of endocarditis [6][7][8] due to Toxocara sp.…”

Larva migrans in India: veterinary and public health perspectives

“…Infection remains asymptomatic most of the times (Bass et al 1987). Fever, hepatomegaly, liver necrosis, spleenomegaly, eosinophilia (Huntley et al1965;Schantz and Glickman 1978;Jain et al 1994;Thakkar et al 2012) and myocarditis (Dao and Virmani 1986;Kim et al 2012) are the important clinical manifestations. Pulmonary involvement can result in cough, wheeze, dyspnea and pneumonia, or asthma (Cianferoni et al 2006).…”