title: Toxocara canis myelitis involving the lumbosacral region: a case report.
abstract: Toxocara canis is a parasite known to cause visceral larva migrans. The infection rarely affects the central nervous system but there have been several reports of myelitis caused by visceral larva migrans due to Toxocara canis. In previous reported cases, the lesions were located in the thoracic or cervical spinal cord. To the best of our knowledge, this is the first report of a lesion involving the lumbosacral region.
  
  
  
  A 60-year-old man developed weakness and dysesthesia in the lower limbs. The symptoms resolved spontaneously, but recurred after five months. One month later, the patient developed pollakiuria and constipation. He was a dog owner and frequently ate raw chicken meat and beef liver. Sagittal T2-weighted image (T2WI) showed swelling and hyperintensity in the spinal cord from T10 to the lumbosacral region and focal nodular enhancement on the posterior segment of the lumbar spinal cord. Blood cell counts showed slight eosinophilia and elevated serum immunoglobulin E level. Cerebrospinal fluid examination showed slight pleocytosis with eosinophilia. Enzyme-linked immunosorbent assay showed high levels of anti-Toxocara antibodies in the serum and cerebrospinal fluid. In addition, confirmatory test by Western blot was positive. The patient was initially treated with intravenous methylprednisolone with slight improvement in muscle weakness. Albendazole was added with a second course of intravenous methylprednisolone. The muscle weakness in the lower limbs improved considerably, and swelling and hyperintensity on T2WI almost disappeared.
  
  
  
  Our results suggest that Toxocara canis myelitis cannot be discounted even if the myelitis involves the lumbosacral region.
authors.affiliation: a Department of Neurology and Geriatrics , Kagoshima University Graduate School of Medical and Dental Sciences , Sakuragaoka 8-35-1, Kagoshima City , Kagoshima 890-8520 , Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Hiramatsu
authors.affiliation: a Department of Neurology and Geriatrics , Kagoshima University Graduate School of Medical and Dental Sciences , Sakuragaoka 8-35-1, Kagoshima City , Kagoshima 890-8520 , Japan.
authors.forename: Michiyoshi
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: b Department of Neurology , Fujimoto General Hospital , Hayasuzu 17-1, Miyakonojo City , Miyazaki , 885-0055 , Japan.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Saigo
authors.affiliation: a Department of Neurology and Geriatrics , Kagoshima University Graduate School of Medical and Dental Sciences , Sakuragaoka 8-35-1, Kagoshima City , Kagoshima 890-8520 , Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Arata
authors.affiliation: a Department of Neurology and Geriatrics , Kagoshima University Graduate School of Medical and Dental Sciences , Sakuragaoka 8-35-1, Kagoshima City , Kagoshima 890-8520 , Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Okamoto
authors.affiliation: a Department of Neurology and Geriatrics , Kagoshima University Graduate School of Medical and Dental Sciences , Sakuragaoka 8-35-1, Kagoshima City , Kagoshima 890-8520 , Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Matsuura
authors.affiliation: c Parasitic Diseases Unit, Department of Infectious Diseases , Faculty of Medicine, University of Miyazaki , 5200 Kihara, Kiyotake , Miyazaki , 889-1692 , Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Maruyama
authors.affiliation: a Department of Neurology and Geriatrics , Kagoshima University Graduate School of Medical and Dental Sciences , Sakuragaoka 8-35-1, Kagoshima City , Kagoshima 890-8520 , Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takashima
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D006801:Humans; D008161:Lumbosacral Region / Q000000981:diagnostic imaging / Q000382:microbiology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009187:Myelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012698:Serologic Tests; D017166:Toxocara canis / Q000276:immunology / Q000302:isolation & purification* / Q000472:pathogenicity
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone
keywords: Albendazole; Lumbosacral region; Myelitis; Toxocara canis; Visceral larva migrans
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