P011 - A large series of Toxocara canis myelitis

Abstract

Background/objectives The etiology of isolated myelitis is often difficult to find. Helminthic infections of the spinal cord are thought to be very rare. The diagnosis is usually suspected in patients with myelitis and CSF and/or blood eosinophilia. In the current case-series study, we report 20 cases of isolated Toxocara myelitis recruited at the American University of Beirut, with full description of the clinical presentation, laboratory data, MRI findings, and response to antihelminthic treatment. Design and methods Clinical and laboratory data were collected for 20 patients who presented with evidence of spinal cord disease. The clinical presentation included sensory, motor, and autonomic dysfunction, predominantly in the lower extremities. Results Patients exhibited a subacute or chronic course; this was either slowly progressive or remitting-relapsing with mild to moderate disability. The patients underwent extensive blood and CSF studies as well as MRI of the spinal cord and brain. Eosinophilia was not a universal finding; only 2 patients had a high eosinophil count in the CSF, although blood eosinophilia was seen in 6 patients. All patients tested positive for Toxocara canis antibodies in the blood and CSF. MRI of the spinal cord revealed a single characteristic lesion with fusiform enlargement that was isointense on T1-weighted images and hyperintense on T2-weighted images. Nodular enhancement was seen after gadolinium injection. MRI of brain was normal in all the cases. Treatment with albendazole, with or without steroids, resulted in marked neurologic improvement and normalization of the MRI in all patients. Conclusions The finding of a single inflammatory MRI lesion in the spinal cord with positive Toxocara canis serology in the blood and CSF in cases of subacute or chronic myelitis suggests the diagnosis of Toxocara myelitis, irrespective of the presence of eosinophilia. All these cases showed good clinical outcomes once treated with antihelminthic agents.