Human
toxocariasis is the most prevalent
helminthiasis in Korea and other industrialized countries. The clinical features of
toxocariasis are diverse, according to the involved organ. Typically, Toxocara spp.
infection is easily treated with 400 mg
albendazole twice a day for 5 days. However, we experienced a case of recurrent
toxocariasis that was refractory to this standard
therapy and presented with
urticaria, an uncommon symptom in
toxocariasis. A 35-year-old male visited our emergency room because of
abdominal pain. He had recently consumed raw cow liver (3 weeks prior to presentation). Laboratory analyses revealed
eosinophilia (1,612 cells/µL) and increased total
IgE (3,060 IU/mL). Chest X-ray showed multiple lung nodules in both lungs, and computed tomography revealed multiple ground-glass opacities in both lungs and multiple tiny
liver abscesses. Liver biopsy revealed an eosinophilic
abscess.
Enzyme-linked
immunosorbent assay findings for Toxocara
antigens were positive (optical density, 2.140), leading to a diagnosis of
toxocariasis. We initiated a 5-day treatment with
albendazole and
prednisolone; however, 6 days after completing the treatment, the patient again experienced
urticaria and severe
itching that could not be controlled by
antihistamines or
hydrocortisone cream. A second bout of
eosinophilia suggested recurring
toxocariasis, for which we prescribed a second round of
albendazole. Despite an initial improvement in his symptoms, the patient returned after 6 weeks complaining of
abdominal pain for 6 hours, which was reminiscent of his first attack; he also exhibited
eosinophilia. Accordingly,
albendazole was administered once more for an additional 3 weeks, and his symptoms resolved.