Takakura Akira, Harada Shinya, Katono Ken, Igawa Satoshi, Katagiri Masato, Yanase Nobuo, Masuda Noriyuki
Kansenshogaku Zasshi. 2015 Mar;89(2):265-9. doi: 10.11150/kansenshogakuzasshi.89.265.
We report herein on a case strongly suspected of being pulmonary toxocariasis. A 22-year-old Indonesian man referred to our hospital presented with abnormal chest shadows upon medical examination. He had no symptoms. He did not have any pets nor did he eat raw beef or chicken. Hematological examination revealed eosinophilia and elevation of IgE. Chest computed tomography revealed 3 pulmonary nodules with the halo sign. We suspected a parasite infection and performed antiparasite antibody testing. Ascaris suum was slightly positive on the screening test. As specific antibody against the larval excretory-secretory products of Toxocara canis, measured at the National Institute of Infectious Diseases, was positive (level 3 up to 8). Subsequently, the abnormal chest shadows disappeared. However, two months later, 2 pulmonary nodules with the halo sign reappeared in other places. Diagnostic therapy with albendazole was performed for 8 weeks. Mild hepatic impairment emerged during therapy, but it was within the allowed range. Thereafter, the results improved for the imaging findings, eosinophilia, serum IgE level, and specific antibody. The antibody level became negative two months after the treatment had ended. We should consider toxocariasis in the differential diagnosis of migratory nodular shadows with the halo sign on chest computed tomography, and immunoserological testing is useful for the diagnosis.
我们在此报告一例高度疑似肺弓首线虫病的病例。一名22岁的印度尼西亚男子因胸部体检发现异常阴影而转诊至我院。他没有任何症状。他没有养任何宠物，也不吃生牛肉或鸡肉。血液学检查显示嗜酸性粒细胞增多和IgE升高。胸部计算机断层扫描显示3个肺部结节并有晕征。我们怀疑是寄生虫感染并进行了抗寄生虫抗体检测。蛔虫筛查试验呈弱阳性。在国立传染病研究所检测的针对犬弓首线虫幼虫排泄分泌产物的特异性抗体呈阳性（滴度为3至8）。随后，胸部异常阴影消失。然而，两个月后，其他部位又出现了2个有晕征的肺部结节。使用阿苯达唑进行了8周的诊断性治疗。治疗期间出现轻度肝功能损害，但在允许范围内。此后，影像学表现、嗜酸性粒细胞增多、血清IgE水平和特异性抗体的结果均有所改善。治疗结束两个月后抗体水平变为阴性。对于胸部计算机断层扫描显示有晕征的游走性结节阴影进行鉴别诊断时，应考虑弓首线虫病，免疫血清学检测对诊断有帮助。
