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[Intracerebral granuloma with serum anti-human ascaris antibody: case report]
T Taira1, T Beppu, K Matsumori
1Department of Neurosurgery, Sagamihara National Hospital, Kanagawa, Japan.
Insights
A child
Area of Science:
- Neurology
- Parasitology
- Immunology
Background:
- Intracerebral granulomas can present with diverse etiologies.
- Toxocara larva migrans is a zoonotic parasitic infection.
- Neurotoxocariasis is a rare but serious manifestation of Toxocara infection.
Observation:
- A 1.5-year-old girl presented with seizures due to a right frontal lobe granuloma.
- Serum tested positive for anti-human ascaris antibody; fecal examination was negative for parasite ova.
- The patient had close contact with household cats, a potential source of Toxocara.
Findings:
- The granuloma was suspected to be caused by Toxocara larva migrans, exhibiting cross-reactivity with human Ascaris.
- Histological analysis showed no eosinophilic infiltration within the granuloma.
- Cerebrospinal fluid revealed elevated protein levels, but systemic reactions like eosinophilia and hepatomegaly were absent.
Implications:
- This case highlights the diagnostic challenge of neurotoxocariasis, especially when parasite ova are not detected.
- The immunological cross-reactivity between Toxocara and Ascaris complicates serological diagnosis.
- Findings suggest that neurotoxocariasis, even without systemic signs, should be considered in pediatric intracerebral granuloma cases.
Abstract:
A 1.5-year-old girl with a convulsion attack due to intracerebral granuloma in the right frontal lobe is reported. Her serum was positive with anti-human ascaris antibody, although no ova of the parasites were detected in the feces. She had grown up intimately with several cats in the home. These findings suggested that the granuloma was due to larva migrans of toxocara, which cross-reacts immunologically with human ascaris. Histological examination of the granuloma revealed no eosinophilic infiltration. No systemic reactions such as eosinophilia and hepatomegaly were found except for elevation of protein in cerebrospinal fluid. These were similar to those of ocular type of toxocara larva migrans.