The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical Evaluation of Toxocariasis Presenting as a Liver Abscess

간농양으로 발현된 톡소카라증의 임상적 고찰

  • Joo, Dong-Wook (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Kim, Byung-Seok (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Ha, Kyung-Ho (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Park, Kyoung-Chan (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Ryu, Jung-Il (Department of Internal Medicine, Catholic University of Daegu School of Medicine) ;
  • Lee, Chang-Hyeong (Department of Internal Medicine, Catholic University of Daegu School of Medicine)
  • 주동욱 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 김병석 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 하경호 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 박경찬 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 류정일 (대구가톨릭대학교 의과대학 내과학교실) ;
  • 이창형 (대구가톨릭대학교 의과대학 내과학교실)
  • Published : 2012.04.01
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Abstract

Background/Aims: Toxocariasis rarely causes a liver abscess. We assessed clinical and laboratory manifestations as well as therapeutic responses in patients with toxocariasis presenting as a liver abscess. Methods: Fourteen patients with toxocariasis presenting as a liver abscess were analyzed retrospectively. Symptoms, occupational history, dietary habits, contact with pets, allergic disease, peripheral eosinophil count, serum immunoglobulin E (IgE) level, and invasion to other organs were evaluated. After treatment with albendazole, follow-up was conducted with abdominal computed tomography (CT) and the measurement of serum eosinophil and IgE levels. Results: Among 568 patients with a liver abscess, 14 were diagnosed with active toxocariasis. The mean age of the patients was 48 years, and nine (64%) were men. Four (28.6%) patients had pain in the right upper quadrant of the abdomen or epigastric area, one had cough, and the others (64.3%) had no symptom. Pulmonary involvement was noted in five patients and colon involvement in one. Six (42.9%) patients had a recent history of eating raw meat. Initial laboratory findings showed increased eosinophil and IgE levels in all patients. The initial CT showed one or multiple ill-defined, hypodense lesions in the liver. After 1 month of albendazole treatment, eosinophil counts were normalized or had decreased in 13 (93%) patients. On follow-up CT, liver abscesses disappeared within 6 months after therapy in 92% of patients. Conclusions: Symptoms, laboratory findings, and treatment of a liver abscess caused by toxocariasis differ from those of a pyogenic liver abscess. Early serologic testing may increase diagnostic yield and efficacy of treatment in patients with a liver abscess and peripheral eosinophilia.

목적: 성인에서 간농양으로 발현된 톡소카라증 환자들을 분석하여 임상양상, 검사 소견, 치료 및 경과를 알아보고자 하였다. 방법: 2008년 1월부터 2011년 7월까지 톡소카라증에 의한 간농양 환자 14명을 후향적으로 분석하였다. 환자들의 증상, 직업력, 식습관, 애완동물 접촉 여부, 알레르기 질환 유무, 말초혈액 호산구 수, 혈청 IgE, 다른 장기의 동반 침범 유무 등을 조사하였다. Albendazole 치료 후 CT, 말초혈액 호산구 수, 혈청 IgE를 추적검사하여 반응을 평가하였다. 결과: 총 568명의 간농양 환자 중 14명(2.5%)에서 톡소카라증에 의한 간농양으로 진단되었으며 남자가 9명, 여자가 5명이었다. 우상복부 또는 심와부 통증이 4예(28.6%), 기침 1예가 있었고 나머지 9예(64.3%)에서는 특이 증상이 없었다. 폐 침범이 5예(35.7%), 대장 침범이 1예(7.1%) 있었으며, 6예(42.9%)에서 소의 육회나 간을 생식한 과거력이 있었다. 직업력, 알레르기 병력에서는 특이사항이 없었으며 애완동물과 접촉한 경우도 없었다. 내원 초기 혈액검사에서 호산구 수와 IgE는 모두 상승되어 있었고 초기 복부 CT에서는 단일 또는 다발성의 경계가 불분명한 저음영 병변이 관찰되었다. Albendazole 치료 1개월 후 호산구 수는 대부분(93%) 정상화 또는 감소되었으나 IgE는 다양한 반응을 보였다. CT에서 관찰되었던 간농양은 치료 6개월 내에 대부분(92%)의 환자에서 소실되었다. 결론: 톡소카라증에 의한 간농양은 일반적인 화농성 간농양과는 임상양상, 검사 소견, 치료 등에서 차이점을 보인다. 호산구 증가증을 동반한 간농양 환자에서 조기에 톡소카라 항체를 포함한 혈청 검사가 시행된다면 진단 및 치료에 도움을 줄 수 있을 것이다.

Keywords

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