J Korean Soc Radiol.  2018 Nov;79(5):286-289. 10.3348/jksr.2018.79.5.286.

Toxocariasis Mimicking Lymphoma and Presenting as Multiple Lymphadenopathy: A Case Report

• Choi Y
• Park CM
• Kim JW
• Park YS
• Lee J
• Choi JW
• Kim KA
• Lee CH

• KMID: 2422907
• DOI: http://doi.org/10.3348/jksr.2018.79.5.286

Abstract

Toxocariasis, a parasitic infection, causes hyper eosinophilia resulting in radiological presentation of eosinophilic infiltrations in the involved organs. In the abdomen, toxocariasis has been reported to manifest as infiltrations in the liver or in the gastrointestinal tract, but it is known to be uncommon to manifest as multiple lymphadenopathy. There have been two case reports of toxocariasis presenting as generalized lymphadenopathy in the chest, neck and inguinal regions. To the best of our knowledge, generalized conglomerated lymphadenopathy occurring mostly in the abdomen from toxocariasis has not been published in the English literature. Herein, we report a rare case of toxocariasis presenting as multiple conglomerated lymphadenopathy mimicking lymphoma on CT.

MeSH Terms

Abdomen
Eosinophilia
Eosinophils
Gastrointestinal Tract
Liver
Lymphatic Diseases*
Lymphoma*
Neck
Thorax
Tomography, X-Ray Computed
Toxocariasis*

Figure

• 

  Fig. 1 A 43-year-old female with multiple lymph node enlargements detected in abdomen and pelvis CT A. Coronal image of contrast enhanced CT shows homogenous enhancing conglomerated lymph nodes (asterick) in the abdomen. No abnormal focal lesions are noted in the liver parenchyma. B. Contrast enhanced abdomen and pelvis CT axial view shows multiple conglomerated lymph nodes (asterick) in the abdomen showing sandwich sign around the mesenteric vessels. C. Axial image of initial chest CT shows left axillary lymphadenopathies. This scan also shows enlarged right axillary and bilateral cervical lymph nodes (not shown in this image). D. PET-CT shows high metabolic uptake in multiple abdominal lymph nodes. E. Four months follow-up CT shows marked decreased sizes oflymph nodes. F. Photomicrograph of biopsy specimen from left axillary lymph node and bone marrow shows inflammatory cell infiltrations predominantly composed of eosinophil granulocytes (arrows) (hematoxylin and eosin stain, × 12.5, × 400). CT = computed tomography, PET = positron emission tomography

Reference

1. Bachmeyer C, Lamarque G, Moraiu R, Molina T, Bourée P, Delmer A. Visceral larva migrans mimicking lymphoma. Chest. 2003; 123:1296–1297.

2. Laroia ST, Rastogi A, Sarin S. Case series of visceral larva migrans in the liver: CT and MRI findings. Int J Case Rep Images. 2012; 3:7–12.

3. Van Laethem JL, Jacobs F, Braude P, Van Gossum A, Deviere J. Toxocara canis infection presenting as eosinophilic ascites and gastroenteritis. Dig Dis Sci. 1994; 39:1370–1372.

4. Chira O, Badea R, Dumitrascu D, Serban A, Branda H, Hajjar N, et al. Eosinophilic ascites in a patient with toxocara canis infection. a case report. Rom J Gastroenterol. 2005; 14:397–400.

5. Szczepan´ski T, Son´ta-Jakimczyk D, Janik-Moszant A, Olejnik I. Generalized lymphadenopathy as initial presentation of toxocariasis in a seven-year-old boy. Pediatr Infect Dis J. 1996; 15:717–718.

6. Ortega CD, Ogawa NY, Rocha MS, Blasbalg R, Caiado AH, Warmbrand G, et al. Heminthic diseases in the abdomen: an epidemiologic and radiologic overview. Radiographics. 2010; 30:253–267.

7. Merdin A, Ogur E, Çiçek Kolak Ç, Avcı Merdin F. A rare cause of hypereosinophilia: a case report. Turkiye Parazitol Derg. 2016; 40:114–116.

8. Roldan WH, Rubinsky-Elefant G. Immunodiagnosis of Human Toxocariasis. In : Al-Moslih M, editor. Serological Diagnosis of Certain Human, Animal and Plant Diseases. 1st ed. Rijeka: InTech;2012. p. 97–112.

9. Fillaux J, Magnaval JF. Laboratory diagnosis of human toxocariasis. Vet Parasitol. 2013; 193:327–336.

10. Despommier D. Toxocariasis: clinical aspects, epidemiology, medical ecology, and molecular aspects. Clin Microbiol Rev. 2003; 16:265–272.