Migration of Toxocara Canis into the spinal Cord in Poorly Treated Patients (P6.327)

Objective: To present an unusual magnetic resonance imaging (MRI) feature of Toxocara canis myelitis demonstrating the migration of the lesion in the spinal cord in two cases. Background: Although Toxocara myelitis is a rare entity, 17 cases were recently diagnosed in Lebanon at the American University of Beirut and published. Radiological features of the Visceral Larva Migrans (VLM) of the Toxocara Canis responsible for the spinal cord infection seem to be specific. Lesions on the spinal cord MRI appeared to have predilection to the posterolateral areas of the lower cervical and upper dorsal regions, having a fusiform enlargement with focal nodular enhancement after Gadolinium injection. Two of these patients were poorly treated and necessitating prolonged courses of anti-helminthics agents. Design/Methods: Serial MRI pictures of these two patients were reviewed and followed to attempt to understand the refractoriness to treatment with anti-helminthics in these patients. Results: Migration of this pathogen which was manifested by the migration of the lesion on the follow up spinal cord MRI was noticed in these patients. In the first case, the lesion migrated upward from C8 to C2-C3 level and in the second, the lesion migrated downward from C2-C3 to C4 level in the cervical spinal cord. Conclusion: This Larva which is known to migrate in blood and solid organs seems also to circulate into the spinal cord through the meninges and cerebrospinal fluid (CSF) either in the upward or downward direction. In this particular condition, the treatment with anti-heminthic agents should be continued until complete resolution of the clinical signs and symptoms with the normalization of the spinal cord MRI of Toxocara myelitis. No Disclosure. Disclosure: Dr. Jabbour has nothing to disclose. Dr. Atweh has nothing to disclose. Dr. Atweh has nothing to disclose.