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Lymphedema as a presenting sign of toxocariasis
J Amir1, L Harel, T Eidlitz-Markus
1Dept. of Pediatrics C, Children's Medical Center in Israel, Sackler School of Medicine, Tel Aviv University, Israel.
Insights
Toxocariasis, a parasitic infection, can manifest as lymphedema in children. This case highlights the importance of considering toxocariasis in pediatric cases of unexplained limb swelling and eosinophilia.
Area of Science:
- Pediatric Infectious Diseases
- Parasitology
- Clinical Manifestations of Helminthic Infections
Background:
- Toxocariasis is a common helminthic zoonosis, typically asymptomatic in children.
- Clinical presentations of toxocariasis are often non-specific, including visceral, ocular, or covert forms.
- Lymphedema is an uncommon presentation of toxocariasis in pediatric populations.
Observation:
- A 24-month-old boy presented with bilateral foot lymphedema and limping.
- Initial laboratory findings included leucocytosis and eosinophilia.
- Other potential causes for edema were systematically excluded.
Findings:
- Enzyme-linked immunosorbent assay (ELISA) confirmed high-titer toxocariasis (>= 1:4,096).
- The child's lymphedema and limping resolved spontaneously within three weeks.
- This case suggests a direct link between toxocariasis and pediatric lymphedema.
Implications:
- Toxocariasis should be included in the differential diagnosis for pediatric lymphedema, especially when accompanied by eosinophilia.
- Early diagnosis and consideration of parasitic infections can prevent extensive workups for other etiologies.
- This case expands the spectrum of clinical presentations associated with Toxocara infections in children.
Abstract:
Toxocariasis in children is usually an asymptomatic infection and those with clinical illness have non-specific systemic or local manifestations. We present a 24-month-old boy with bilateral lymphedema of the feet as the main clinical manifestation of toxocariasis. The child presented with limping and nonpitting edema of both feet. Laboratory investigation revealed leucocytosis of < 20,000/mm3 with a differential count of < 50% eosinophils. No other cause of edema was found. The ELISA for toxocariasis revealed a high titer of > or = 1:4,096. The limping and the lymphedema disappeared during the third week of his illness. We suggest that toxocariasis should be considered as a possible cause of lymphedema and eosinophilia in young children.