Severe Toxocariasis in Children-Diagnostic Difficulties

We present the case of an 18-month-old girl, from rural area, admitted to our clinic for fever and cough. The anamnestic data and the clinical and radiological examinations initially suggested the diagnosis of acute interstitial pneumonia. During hospitalization, she repeatedly presented exacerbations with acute respiratory failure, but without fever. Paraclinic examinations revealed anemia, leukocytosis, inflammatory tests with highly increased values, low values of serum iron and serum calcium, hyperproteinemia with hypergammaglobulinemia, the values of IgE and IgG being highly increased. Repeated pulmonary x-rays-peribronchovascular interstitial thickening, at the level of peri-and right infrahilar area. Medullary puncture-increased percentage of eosinophils in several stages of maturity, approximately 20%, normal values for the other medullary series, without atypical cells; the fingertip hemogram showed anemia, leukocytosis, eosinophilia. The diagnosis turned to a possible toxocariasis-atc anti toxocara canis=55.6 NTU. In the third week of hospitalization, the patient presented short crises of nonfebrile seizures. Normal CT and EEG brain. The child was discharged after 5 weeks, the diagnosis being severe toxocariasis with pulmonary and neurological manifestations; she was recommended an antiparasitary treatment and remained in our clinic's records.