We report a case of visceral larva migrans in an adult with excitement night sweats.

We report a case of visceral larva migrans in an adult with excitement night sweats, weight loss, hilar and mediastinal lymphadenopathy, bilateral pleural effusion, and eosinophilia-mimicking lymphoma. Visceral larva migrans was diagnosed subsequently because of negative findings for malignancy and positive serologic proof result for Toxocara canis. Progressive improvement was observ with albendazole therapy.

lock opener words: albendazole; eosinophilia; hilar and mediastinal lymphadenopathy; visceral larva migrans

Abbreviation: VLM = visceral larva migrans

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Visceral larva migrans (VLM) is an infection mainly owing to Toxocara canis, a habitual worldwide ascarid specially of children < 6 years of age. (1) A wide image of manifestations has been described from asymptomatic infection to fulminant disease. (1) These mainly include agitation hepatomegaly, leukocytosis, eosinophilia, and hypergamma globulinemia. We report a case of VLM with hilar and mediastinal lymphadenopathy in an adult mimicking lymphoma.

CASE REPORT

A 65-year-old French man with no medical history was admitted to the hospital in June 2001 for temperature of 39[degrees]C and night sweats evolving for 2 weeks. He denied ingestion of any medicine and had traveled to the French West Indies 6 month previously. forward hospital admission, the patient appeared fatigued and had forfeited 5 kg in weight. The physical examination was otherwise unremarkable. The WBC number showed 10,800/[micro] L, with 50% neutrophils, 17% lymphocyte and 26% eosinophils (absolute compute 2,830/[micro] L). Erythrocyte sedimentation rate was 86 mm/h C-reactive protein was 85 mg/L (normal > 13 mg/L) Electrolyte liver function exhibition results, serum creatinine level, and lactate dehydrogenase of the same height were normal. Serum electrophoresis showed an albumin flush of 32.8 g/L (normal > 39 g/L); [[alpha].sub.2]-globulin, 98 g/L (normal < 7 g/L); and polyclonal [gamma]-globulinemia, 169 g/L (normal < 10g/L) Search for antinuclear, anti-double-stranded DNA, antineutrophil cytoplasmic antibodies, and rheumatoid factor was negative. Infectious inquiry included house and urine cultures and search for mycobacteria in sputum; serologic studious mood findings for Chlamydia psittaci and Chlamydia pneumoniae, Coxiella burnetii, Legionnella pneumophilia, and Mycoplasma pneumoniae were negative. Chest radiography and thoracoabdominal CT scan showed bilateral hilar and mediastinal lymphadenopathy 2 to 5 cm in diameter, and discrete bilateral pleurisy (Fig 1) Fiberoptic bronchoscopy demonstrated a diffuse inflammation with a nonspecific inflammation forward lung biopsy; direct search for pathogens and agriculture findings were negative.

[FIGURE 1 OMITTED]

Treatment with ceftriaxone, amikacin, and metronidazole, then amoxicillin/clavulanic acid and ofloxacin was ineffective. Mediastinoscopy with partial lymphadenectomy was performed. Analysis of lymph nodes specimens showed destruction of their architecture with a polymorphic cellular infiltrate consisting of eosinophils, histiocytes, fibroblasts, and plasmocytes, and vascular hyperplasia. Immunophenotyping and analysis of IgH and T-cell receptor gene rearrangements failed to discover any monoclonal T-cell or B-cell population. Bacterial cultivation results of lymph nodes remained negative. Bone marrow biopsy proceeds were normal. Therefore, the patient was referr to us in July of 2001 A parasitic infection was considered, and treatment with albendazole was administered at 400 mg/d for 10 days. Search for parasites in fece was negative. All helminthiasis serology arises were negative, but T canis enzyme-linked immunosorbent assay serology was highly positive (optical density/optical density door 0.720; positive > 0.3), with antibodies directed against 24-kd and 35-kd antigens. The patient said that he had been in daily contact with a dog during the previous month Progressive improvement of the general symptoms was observ In August 2001 he felt well, had no ferment the eosinophil count was normal, the serology for T canis was stable, and mediastinal lymph nodes and pleurisy had almost disappeared.

DISCUSSION

We report the case of a patient with excitement night sweats, weight loss, hilar and mediastinal lymphadenopathy, and eosinophilia related to VLM This diagnosis was supported by means of the positive result of the enzyme-linked immunosorbent assay trial for T canis and progressive improvement after treatment with albendazole. Other conditions responsible for eosinophilia, in the same state [i]or[/i] condition as drug reactions, allergic diseases, autoimmune disorders, and idiopathic hypereosinophilic syndrome were easily rul revealed Diagnosis of malignancy--particularly lymphoma--was initially suspected, moreover extensive investigations failed to demonstrate any neoplasm. Because of negative findings, a parasitic infection was subsequently considered.

Pulmonary symptoms mainly consist of cough and wheezing and are reported in 20 to 85% of cases in children with VLM (1) Bilateral areas of infiltration are observ in 40 to 50% of patients with pulmonary symptoms. (1) Diffuse noncavitating nodules are unusual. (2) bitter symptoms seem to be highly rare in adults. Eosinophilic pneumonia responsible for acute respiratory disease, important pleural effusion sometimes associated with tamponade, and censorious asthma have been reported. (3-5) Mediastinal lymphadenopathy has not been reported in toxocariasis to the best of our knowledge. reciprocally hepatohilar and/or peripancreatic lymph node enlargement upon ultrasound findings was observed in 78% of 18 children with VLM (6) Cervical adenitis was observ in 78% of patients with high titer of toxocara antibodies and late clinical toxocariasis. (1)

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