Persistent eosinophilia following treatment for pediatric pyogenic liver abscess: A case report

This case report describes a case of pyogenic liver abscess potentially associated with toxocariasis, a rare disease in the United States. A 3-year-old girl presented with new abdominal pain and fever. Contrasted computed tomography of the abdomen revealed a 2-cm hepatic abscess, which was subsequently drained. Culture of abscess fluid grew methicillin-resistant Staphylococcus aureus, and the patient was treated with intravenous vancomycin before transition to clindamycin and discharge home. Further laboratory evaluation yielded persistent eosinophilia and elevated IgE levels, with ambiguous primary immunodeficiency genetic testing. The patient's hepatic abscess resolved; however, persistent eosinophilia prompted a parasitic workup, which returned positive for Toxocara IgG. The patient was thereafter treated with albendazole with subsequent decrease in eosinophil levels. This case report brings attention to a pediatric pathology previously unreported in the United States: toxocariasis potentially associated with development of pediatric methicillin-resistant S. aureus-associated pyogenic liver abscess.