Clinical Features, Magnetic Resonance Imaging (MRI) Findings, and Treatment Outcome in 17 Patients

Abstract: Toxocara myelitis is a rare disease. Few cases have beenreported in the literature. Patients present with myelopathy, occasionaleosinophilia in blood and cerebrospinal fluid (CSF), with abnormalsignals on magnetic resonance imaging (MRI). In the current study wereport 17 cases of isolated Toxocara myelitis from a single tertiary re-ferral center in Lebanon, with description of the clinical presentation,laboratory data, MRI findings, and response to antihelminthic treatment.Clinicalandlaboratorydatawerecollectedfor17patientswhopresentedwith evidence of spinal cord disease. The clinical presentation includedsensory, motor, and autonomic dysfunction, predominantly in the lowerextremities. Patients exhibited a subacute or chronic course; this waseither slowly progressive or remitting-relapsing with mild to moderatedisability. The patients underwent extensive blood and CSF workup aswell as MRI of the spinal cord and brain. Only 2 patients had a higheosinophil count in the CSF, although blood eosinophilia was seen in 6patients. All patients tested positive for Toxocara canis antibodies inthe blood and CSF. MRI of the spinal cord revealed a single charac-teristic lesion in the spinal cord with fusiform enlargement that wasisointense on T1-weighted images and hyperintense on T2-weightedimages. Nodular enhancement was seen after gadolinium injection.Treatmentwithalbendazole,withorwithoutsteroids,resultedin markedneurologic improvement and normalization of the MRI in all patients.The finding of a single inflammatory MRI lesion in the spinal cordwith positive Toxocara canis serology in the blood and CSF in cases ofsubacuteorchronicmyelitissuggeststhediagnosisofToxocaramyelitis,irrespective of the presence of eosinophilia. Antihelminthic treatmentis associated with a good outcome.(Medicine 2011;90: 337Y343)Abbreviations: AI = Hauser Ambulation Index, ANA = antinuclearantibodies,CSF=cerebrospinalfluid,CNS=centralnervoussystem,HIV = human immunodeficiency virus, MRI = magnetic resonanceimaging.