MYSTERY STORY
Eosinophilia, Fever, Hepatospienomegaly
and
Wheezing
Contributed by Mohsen Ziai, M.D.
A
F~ 4~-YEAR-OLD BOY, ~f.E~., M.E., was brought to me by a pediatrician for consultation. The diagnosis of eosinophilic leukemia had been made by clinics for this child because of the WBC counts 45 and 55 thousand, of which per cent had been eosinophils on numerous occasions. Aspiration of bone marrow for the establishment of diagnosis had been suggested to the family but they had refused this procedure. In addition there was a history of fever going back several months. This fever had been low grade and intermittent. On further questioning, a history of cough and intermittent wheezing was also given. In addition, a chest x-ray, which had been taken during one of these episodes of coughing and wheezing, was reexamined and it demonstrated a rather homogeneous infiltration throughout both lung fields. Physical examination was unremarkable except for mi!d hepatospienomega~y. Liver was 2 cm below the right costal margin and the spleen tip was two
ranging between nearly 75 to 80
easily palpable. The diagnosis of visceral larva migrans was made on this patient and further confirmed by immonoelectrophoretic studies which demontrated moderate hyperglobulinemia. Professor of Pediatrics Tehran University, Lecturer in Pediatrics Johns Hopkins University.
Comment One should think of the diagnosis of visceral larva migrans whenever there is severe eosinophilia of unexplained nature. This disease is caused by dog and cat ascaris. The organisms are known as Toxocara canis and occasionally Toxocara cati. These parasites cannot complete their life cycles in human beings and they produce a very severe inflammatory reaction in the organs which they invade as well as eosinophilia. Eventually, a wall is built by fibrous tissue arqund these larvae and the organisms die. It is important to remember that this infestation can involve the eyes causing pathological changes in the retina and the vitreous chamber. These granulomatous lesions can be large in the eyes and sometimes mistaken for intraocular tumors leading to unnecessary inucieation. This diagnosis must always be considered as part of the differential diagnosis of intraocular tumors before decision about surgery is made. The natural course of the disease is usually favorable and the process burns out by itself. Occasionally respiratory difficulties are severe and there may even be a fatal outcome. Steroid therapy is sometimes advocated, but its value remains questionable. ’
313
Downloaded from cpj.sagepub.com at NORTH DAKOTA STATE UNIV LIB on July 1, 2015
Eosinophilia, Fever, Hepatospienomegaly
and
Wheezing
Contributed by Mohsen Ziai, M.D.
A
F~ 4~-YEAR-OLD BOY, ~f.E~., M.E., was brought to me by a pediatrician for consultation. The diagnosis of eosinophilic leukemia had been made by clinics for this child because of the WBC counts 45 and 55 thousand, of which per cent had been eosinophils on numerous occasions. Aspiration of bone marrow for the establishment of diagnosis had been suggested to the family but they had refused this procedure. In addition there was a history of fever going back several months. This fever had been low grade and intermittent. On further questioning, a history of cough and intermittent wheezing was also given. In addition, a chest x-ray, which had been taken during one of these episodes of coughing and wheezing, was reexamined and it demonstrated a rather homogeneous infiltration throughout both lung fields. Physical examination was unremarkable except for mi!d hepatospienomega~y. Liver was 2 cm below the right costal margin and the spleen tip was two
ranging between nearly 75 to 80
easily palpable. The diagnosis of visceral larva migrans was made on this patient and further confirmed by immonoelectrophoretic studies which demontrated moderate hyperglobulinemia. Professor of Pediatrics Tehran University, Lecturer in Pediatrics Johns Hopkins University.
Comment One should think of the diagnosis of visceral larva migrans whenever there is severe eosinophilia of unexplained nature. This disease is caused by dog and cat ascaris. The organisms are known as Toxocara canis and occasionally Toxocara cati. These parasites cannot complete their life cycles in human beings and they produce a very severe inflammatory reaction in the organs which they invade as well as eosinophilia. Eventually, a wall is built by fibrous tissue arqund these larvae and the organisms die. It is important to remember that this infestation can involve the eyes causing pathological changes in the retina and the vitreous chamber. These granulomatous lesions can be large in the eyes and sometimes mistaken for intraocular tumors leading to unnecessary inucieation. This diagnosis must always be considered as part of the differential diagnosis of intraocular tumors before decision about surgery is made. The natural course of the disease is usually favorable and the process burns out by itself. Occasionally respiratory difficulties are severe and there may even be a fatal outcome. Steroid therapy is sometimes advocated, but its value remains questionable. ’
313
Downloaded from cpj.sagepub.com at NORTH DAKOTA STATE UNIV LIB on July 1, 2015
![[A 28-year-old man with hepatosplenomegaly and fever].](/assets/img/hold.png)
