Korean J Gastroenterol.  2015 Apr;65(4):222-228. 10.4166/kjg.2015.65.4.222.

Enhanced Resolution of Eosinophilic Liver Abscess Associated with Toxocariasis by Albendazole Treatment

• Jang EY
• Choi MS
• Gwak GY
• Koh KC
• Paik SW
• Lee JH
• Paik YH
• Yoo BC

• KMID: 2373213
• DOI: http://doi.org/10.4166/kjg.2015.65.4.222

Abstract

BACKGROUND/AIMS
Visceral larva migrans, caused by Toxocara canis and Toxocara cati, has emerged as a significant cause of eosinophilic liver abscess (ELA). Differentiation of ELA associated with toxocariasis (ELA-T) from metastasis or primary liver malignancy is sometimes difficult. However, the role of albendazole treatment remains uncertain in this condition. The aim of this study was to evaluate whether albendazole can enhance the radiologic resolution of ELA-T.
METHODS
We retrospectively reviewed the medical records of the patients diagnosed with ELA-T at our institution between January 2008 and December 2011. ELA-T was diagnosed based on the imaging findings on computed tomography or magnetic resonance imaging and the presence of positive serum IgG antibody for Toxocara canis. Among a total of 163 patients, 32 patients received albendazole (albendazole group) and 131 did not (control group). Baseline characteristics and fate of liver nodules were compared between the two groups.
RESULTS
Baseline characteristics (age, sex, number and maximal size of lesions, eosinophil count) were similar between the two groups. Median duration for achieving radiologic resolution in the albendazole group was significantly shorter than in the control group (207 days [range 186-228] vs. 302 days [range 224-380], p=0.023). In Cox regression analysis of the cumulative rates of radiologic resolution, the hazard ratio for albendazole treatment was 1.99 (95% confidence interval, 1.22-3.23).
CONCLUSIONS
Radiologic resolution of ELA-T can be accelerated with albendazole treatment. Hence, inconvenience associated with long-term follow-up and unnecessary worries among patients can be eliminated with albendazole treatment.

Keyword

Toxocariasis; Larva migrans, visceral; Liver abscess; Liver diseases, parasitic; Albendazole

MeSH Terms

Adult
Aged
Aged, 80 and over
Albendazole/*therapeutic use
Animals
Antiprotozoal Agents/*therapeutic use
Eosinophils/*immunology
Female
Humans
Immunoglobulin G/blood
Larva Migrans, Visceral/*drug therapy/parasitology
Liver/enzymology/metabolism
Liver Abscess/*etiology
Magnetic Resonance Imaging
Male
Middle Aged
Proportional Hazards Models
Retrospective Studies
Tomography, X-Ray Computed
Toxocara canis/immunology/isolation & purification
Albendazole
Antiprotozoal Agents
Immunoglobulin G

Figure

• 

  Fig. 1. CT findings in a 51-year-old female patient with an eosinophilic liver abscess. (A) A 1.4-cm nodule (arrow) was poorly delineated in the arterial phase. (B) It presented as an ill-defined low-attenuation nodule (arrow) in the portal phase. (C) It was also invisible (arrow) in the equilibrium phase.

• 

  Fig. 2. Image findings in a 51-year-old female patient with an eosinophilic liver abscess before (A-C) and after (D-F) albendazole treatment. The gadolinium-enhanced dynamic MR findings showed (A) low-signal intensity on unenhanced T1-weighted images, (B) high-signal intensity on unenhanced T2-weighted images, and (C) low-signal intensity in the portal phase. The previously identified 1.4 cm nodule (arrows) had completely disappeared 1 year after initial diagnosis (D, arterial phase; E, portal phase; F, equilibrium phase).

• 

  Fig. 3. The enrolled patients in this study. A total of 169 patients with the eosinophilic liver abscesses with toxocariasis (ELA-T) were initially enrolled. Among them, six patients were excluded, and 163 patients were included in the final analysis. While 32 patients received albendazole treatment (albendazole group), 131 patients were followed up without medication (control group).

• 

  Fig. 4. Cumulative rates of radiologic resolution by Kaplan-Meier analysis. Kaplan-Meier analysis showed that the median duration for achieving radiologic resolution was 207 days (range, 186–228 days) in the albendazole group, which was significantly shorter than the median duration for achieving radiologic resolution of 302 days in the control group (range, 224–380 days, p=0.023)

Reference

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