Department of Family Medicine, Hanyang University College of Medicine, Seoul, Korea.
Department of Environmental Biology and Medical Parasitology, Hanyang University College of Medicine, Seoul, Korea.
Am J Trop Med Hyg. 2018 Dec;99(6):1602-1605. doi: 10.4269/ajtmh.18-0199.
Visceral larva migrans (VLM) is one of the clinical syndromes of human toxocariasis. We report a case of hepatic VLM presenting preprandial malaise and epigastric discomfort in a 58-year-old woman drinking raw roe deer blood. The imaging studies of the abdomen showed a 74-mm hepatic mass featuring hepatic VLM. Anti- immunoglobulin G (IgG) was observed in enzyme-linked immunosorbent assay (ELISA) and western blot. Despite anthelmintic treatment, the patient complained of newly developed cough and skin rash with severe eosinophilia. Hepatic lesion increased in size. The patient underwent an open left lobectomy of the liver. After the surgery, the patient was free of symptoms such as preprandial malaise, epigastric discomfort, cough, and skin rash. Laboratory test showed a normal eosinophilic count at postoperative 1 month, 6 months, 1 year, and 4 years. The initial optical density value of 2.55 of anti- IgG in ELISA was found to be negative (0.684) at postoperative 21 months. Our case report highlights that a high degree of clinical suspicion for hepatic VLM should be considered in a patient with a history of ingestion of raw food in the past, presenting severe eosinophilia and a variety of symptoms which reflect high worm burdens. Symptom remission, eosinophilia remission, and complete radiological resolution of lesions can be complete with surgery.
内脏幼虫移行症（VLM）是人体旋毛虫病的临床综合征之一。我们报告了一例 58 岁妇女饮用生鹿血后出现餐前不适和上腹部不适的肝 VLM 病例。腹部影像学检查显示肝内 74mm 肿块，符合肝 VLM 表现。酶联免疫吸附试验（ELISA）和免疫印迹检测到抗免疫球蛋白 G（IgG）。尽管进行了驱虫治疗，但患者仍抱怨新出现的咳嗽、皮疹和严重嗜酸性粒细胞增多。肝病变增大。患者接受了左半肝开放性切除术。术后，患者餐前不适、上腹部不适、咳嗽和皮疹等症状消失。术后 1 个月、6 个月、1 年和 4 年，实验室检查嗜酸性粒细胞计数正常。术后 21 个月，ELISA 中抗 IgG 的初始光密度值 2.55 被发现为阴性（0.684）。我们的病例报告强调，对于过去有生食摄入史、表现为严重嗜酸性粒细胞增多和多种反映高虫负荷的症状的患者，应高度怀疑肝 VLM。症状缓解、嗜酸性粒细胞减少和病变完全放射学缓解可通过手术实现。
