Ecchymoses: an unusual manifestation of toxocariasis in children

Objective To investigate the aetiology of multiple ecchymoses associated with eosinophilia. Setting Professorial Paediatric Unit (PPU) at Lady Ridgeway Hospital (LRH) for children, Colombo. Design Prospective study from July 1998 to April 2000. Materials and methods Patients admitted to the PPU with multiple ecchymoses associated with an absolute eosinophilia (>lxl07l) were investigated further to determine the possible aetiology; bleeding time, clotting time, platelet count, platelet function tests, stools examination and toxocara antibody tests were performed. Patients who were positive for toxocara were treated either with thiabendazole or albendazole. Patients who had geohelminth infestations were treated with mebendazole. Results 14 children (11 boys) were studied. 7 were between 1 and 5 years, and 7 were above 5 years of age. The mean eosinophil count was 4.3x1071. All patients had a prolonged bleeding time, but clotting time and platelet counts (mean value 220x1071) were normal. Platelet function tests were done in 5 patients. Twelve patients were positive for toxocariasis and the other 2 were positive for ascariasis. All children who were positive for toxocariasis had contact with pet cats or dogs. Six patients were treated with thiabendazole and 6 with albendazole. The two patients who had ascariasis were treated with mebendazole. Posttreatment mean eosinophil count was 0.63x1071, and the bleeding time was 4 minutes. Conclusion Toxocariasis could present with ecchymoses due to an acquired bleeding disorder. Awareness of this would help to investigate, diagnose and treat early, and lessen parental anxiety. DOI: http://dx.doi.org/10.4038/cmj.v46i4.6438 Ceylon Medical Journal 2001; 46(4): 130-131