Pulmonary toxocariasis

Case contributed by Dr Yair Glick

Presentation

Chest pain, fever, malaise.

Patient Data

Age: 30 years
Gender: Male
X-ray

Infiltrate in RML, probably with atelectatic component.
Larger infiltrate in LLL.

CT chest, 4 days later:

CT

Large heterogeneous consolidation with proximal air bronchogram in anterior aspect of LLL.
Smaller heterogeneous ovoid consolidation, with denser homogeneous component medially which most probably represents atelectasis, in medial segment of RML.
Small consolidation with air bronchogram in anterobasal segment of RLL.
Several nodules scattered in RLL and LLL.
Non-enlarged right low paratracheal (station 4R) lymph nodes.
No hilar lymphadenopathy.

Follow-up X-ray chest, 6 days after the CT:

X-ray

Partial resolution of the infiltrates.

Case Discussion

Young male presented to the ER with fever, malaise and chest pain. Rhonchi in the lower lung fields on auscultation. History notable for intensive exposure to cats, much less so to dogs.
Lab tests showed marked leukocytosis, throbocytosis, an eosinophil count of 700 (twice the upper limit of normal), CRP ~100, and elevated liver enzymes, predominantly cholestatic. Infiltrates on chest X-ray.
Responded to treatment with Ceftriaxone and Doxycycline which was converted to azitromycin, then to levofloxacin.
The patient was negative for HIV; urine for Legionella - negative; Q-fever - negative; sputum for tuberculosis and nasal and throat swabs for influenza - negative. Sputum for Biofire pneumonia panel - negative for all pathogens.
Serology came back negative for Trichinella but Toxocariasis IgG was strongly positive, wherefore treatment with Albendazole was initiated.

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