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[Ocular toxocariasis in a boy with idiopathic nephrotic syndrome - a case report]
Agnieszka Antonowicz1, Piotr Skrzypczyk1, Beata Kępa2
1Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland.
Insights
Toxocariasis, a parasitic infection, can cause ocular issues and nephrotic syndrome relapses in children. Early screening for Toxocara antibodies is recommended, especially in immunocompromised children with potential exposure.
Area of Science:
- Parasitology
- Ophthalmology
- Pediatrics
Background:
- Toxocariasis is a common zoonotic disease caused by Toxocara larvae.
- Ocular toxocariasis affects 1 in 1,000 to 10,000 children.
- Children with idiopathic nephrotic syndrome (INS) are susceptible to infections, including parasitic infestations that can trigger disease relapses.
Observation:
- A 6-year-old boy with steroid-dependent nephrotic syndrome experienced multiple relapses.
- During a relapse, screening revealed IgG antibodies against Toxocara.
- Fundoscopy showed inflammatory lesions in the retina, leading to an ocular toxocariasis diagnosis.
Findings:
- The patient was treated with albendazole and increased prednisone dosage.
- Follow-up fundoscopic examinations indicated no progression of ocular lesions.
Implications:
- Serological testing for Toxocara infestation is advised for children on immunosuppressive therapy with potential exposure to animals or raw meat.
- Testing is recommended even in the absence of overt parasitic infection symptoms.
- This approach can help identify treatable causes of nephrotic syndrome relapses and prevent ocular complications.
Abstract:
Toxocariasis is a common zoonosis caused by infection with Toxocara canis or cati larvae. Ocular toxocariasis is one of the forms of infestation found in 1/1,000 - 1/10,000 children. Children with idiopathic nephrotic syndrome (INS) are at high risk of infections, also parasitic infestations, which can, in turn, cause relapses of the disease.
A Case Report:
We present a case of a 6-year-old boy with steroiddependent nephrotic syndrome. The disease started at age of 2, the boy had 9 relapses of INS, and was treated with oral prednisone, levamisole, and cyclophosphamide. During hospitalization with Xth relapse of INS, he was screened for causes of recurrences and IgG antibodies against Toxocara were found. Fundoscopy revealed white, slightly elevated, and discoloured inflammatory lesions in right retina without inflammation in the vitreous. Ocular toxocariasis was diagnosed. The boy was treated for 7 days with albendazole in the dose of 15 mg/kg/24 h with simultaneous increase of the dose of prednisone to 1mg/kg/24 h. In control fundoscopic examinations there was no progression of ocular lesions.
Conclusions:
In children on immunosuppressive treatment with possible exposure to animals or raw meet it is advisable to take serological tests for Toxocara infestation also in the absence of clinical symptoms of parasitic infection.
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