Challenging diagnoses of toxocariasis: a report of two cases

The present study illustrates two cases of Toxocara canis infection: a 77-year-old man presenting with bilateral uveitis, sepsis, and non-convulsive status epilepticus (patient A); and a 63-year-old woman with a history of treated breast cancer, presenting with sight loss and paralysis of the right eye, neurological symptoms, pulmonary embolism, pneumonia, and a post traumatic vertebral fracture (patient B). Both diagnoses were challenging because the acute comorbidities withdrew the attention from the actual cause of the disease, and in one case the steroid treatment possibly affected the laboratory indexes. The lack of response to antibiotics and the involvement of specific organs and districts suggested parasitic infection. Indeed, immunoblot assay revealed the presence of specific T. canis immunoglobulin G antibodies. Both patients improved with albendazole 800 mg/die (400 mg ×2) for 28 days; the neurological state normalized, while sight and eye motility remained impaired. Overall, the findings from these two toxocariasis cases indicate that the occurrence of severe neurological symptoms associated with ocular involvement should generate suspicion of parasitic infection rather than leading to differential diagnosis of common presentations such as bacterial and viral infections or autoimmune diseases.