Febrile "migrating" eosinophilic cellulitis with hepatosplenomegaly: adult toxocariasis - a case report

Toxocariasis and Strongyloidiasis as Triggering Factors for Wells' Syndrome

Wells' syndrome is a rare inflammatory skin disease characterized by pruritic erythematous lesions and cutaneous edema, often accompanied by eosinophilia. Parasitic infestations, such as toxocariasis and strongyloidiasis, can serve as triggers. However, Wells' syndrome associated with toxocariasis and strongyloidiasis has not been reported previously in Indonesia. Herein, we present a case of a 27-year-old male with a chief complaint of recurrent, pruritic, and painful erythematous rash on the right lower leg for 6 months, accompanied by fever and diarrhea. Physical examination showed cutaneous edema with erythematous macules and bullae on the affected leg. Peripheral blood eosinophilia was noted, and the histopathological analysis demonstrated flame figures, confirming the diagnosis of Wells' syndrome. A stool culture identified Strongyloides stercoralis, confirming strongyloidiasis, and serological testing was positive for toxocariasis immunoglobulin G antibodies. The patient was treated with albendazole 400 mg twice daily for 3 weeks resulted in clinical improvement observed by the 14th day. The diverse clinical features of Wells' syndrome present a challenge to clinicians in making an accurate diagnosis, which typically hinges on histopathological assessment and identifying flame figures. Therefore, clinicopathological correlation is important to establish an accurate diagnosis.

[Cardiovascular manifestations of human toxocariasis]

Toxocariasis is a parasitic infection produced by helminths that cannot reach their adult stage in humans. For their etiological species (Toxocara canis and Toxocara cati), man is a paratenic host. Infection by such helminths can produce a variety of clinical manifestations, such as: visceral larvae migrans syndrome, ocular larvae migrans syndrome and covert toxocariasis. In the visceral larvae migrans syndrome, the organs that are mainly involved include liver, lungs, skin, nervous system, muscles, kidneys and the heart. Regarding the latter, the importance of cardiovascular manifestations in toxocariasis, as well as its clinical relevance, has increasingly begun to be recognized. The current article is based on a systematic information search, focused mainly on the clinical and pathological aspects of cardiovascular manifestations in toxocariasis, including its pathophysiology, laboratory findings, diagnosis and therapeutical options, with the objective of highlighting its importance as a zoonosis and its relevance to the fields of cardiovascular medicine in adults and children.

Wells syndrome and its relationship to Churg-Strauss syndrome

BACKGROUND

  Wells syndrome has been described as an inflammatory disorder based on typical clinical appearance combined with the histopathological presence of eosinophilic infiltrates and flame figures in the absence of vasculitis. Churg-Strauss syndrome, on the other hand, is primarily a diffuse, necrotizing vasculitis but is also typically displaying eosinophils and flame figures. Despite several parallels, the present understanding of these two diseases excludes any pathogenetic relationship.

METHODS

  We describe the clinical course and histopathological appearance of three patients who had initially been diagnosed with Wells syndrome that developed into Churg-Strauss syndrome during the course of their disease.

RESULTS

  The clinical presentation of all three patients led to the diagnosis of Wells syndrome by independent specialists. Histopathology showed an eosinophilic infiltrate and flame figures next to features of leukocytoclastic vasculitis. Detailed examination revealed asthma bronchiale and additional symptoms indicating Churg-Strauss syndrome. The initial diagnosis of Wells syndrome had to be revised to Churg-Strauss syndrome.

CONCLUSION

  We conclude that Wells syndrome could be the starting point of a pathogenetic process that might reach its maximum in Churg-Strauss syndrome. As a clinical consequence, patients with Wells syndrome should be evaluated and followed for Churg-Strauss syndrome.

Cutaneous simulants of infectious disease

Many cutaneous conditions can mimic infection. If these lesions are not accurately recognized, they may be treated with antimicrobial agents, which adds cost, potential risk, and inconvenience to the patient and the healthcare system. The presenting signs and symptoms of many ulcerating, pustular, morbilliform, bullous, neoplastic, granulomatous, autoimmune, and neutrophilic conditions, as well as clinical vasculitis, cellulitis, folliculitis, and panniculitis, have been mistaken for infection. This review emphasizes the clinical presentation, physical exam, and diagnostic workup of many of these conditions to assist the clinician in ascertaining the correct diagnosis. In addition, general treatment options are provided for each disease category.

Seroprevalence and risk factors for canine toxocariasis by detection of specific IgG as a marker of infection in dogs from Salvador, Brazil

Toxocara canis is a highly prevalent worldwide canine nematode responsible for enzootic and zoonotic infections. It is considered to be one of the main agents of human visceral and ocular larva migrans. False negative diagnosis may occur because adult infected dogs with "dormant" larvae may have negative fecal test results since they usually do not shed parasite eggs in their stools. During pregnancy, the larvae become active and infect the offspring through the placenta. A serological test can distinguish infected animals, thus increasing the accuracy of the diagnosis for epidemiological studies and prophylactic purposes. In the present work a serological investigation was carried out to study the risk factors for the acquisition of this infection in 301 dogs inhabiting the city of Salvador, northeast Brazil. A validated questionnaire was applied to the donors and caretakers to assess animal management practices. All dogs were submitted to clinical evaluation and blood collection. Serum samples were analyzed for IgG antibodies against excretory-secretory products of T. canis larvae, used as antigens, by indirect ELISA. The overall seroprevalence of anti-T. canis IgG antibodies was 82.7%. Risk factors for T. canis infection included sex, area of origin within the city, homemade leftover food intake, failure to receive regular vaccination against infectious diseases and lack of preventive anti-helminthic treatment. Most of these risk factors suggest a lack of veterinary care and poverty. The high frequency of seropositivity found for toxocariasis in dogs suggests that results based on parasitological fecal examination could underestimate the actual prevalence of the infection.