Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 503913, 4 pages doi:10.1155/2011/503913 Case Report Toxocariasis Presenting as Encephalomyelitis Gregory Helsen,1 Stefaan J. Vandecasteele,2 and Ludo J. Vanopdenbosch3 1 Department of Neurology, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium 2 Department of Internal Medicine, General Hospital Sint-Jan, Ruddershove 10, 8000 Bruges, Belgium 3 Department of Neurology, General Hospital Sint-Jan, Ruddershove 10, 8000 Bruges, Belgium Correspondence should be addressed to Gregory Helsen, gregory.helsen@uza.be Received 2 February 2011; Accepted 11 March 2011 Academic Editor: Massimo Gallerani Copyright © 2011 Gregory Helsen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We describe a farmer who presented with a clinical picture of a transverse thoracic myelitis. MRI showed inﬂammatory lesions in brain and thoracic spinal cord. Toxocariasis was suspected because of eosinophilia in blood and cerebrospinal ﬂuid, and this diagnosis was conﬁrmed immunologically. He was successfully treated with antihelminthics in combination with corticosteroids. Neurotoxocariasis is rare and diagnosis can be diﬃcult because of the diﬀerent and atypical clinical manifestations. It should be considered in every case of central neurological syndrome associated with eosinophilia. 1. Introduction Toxocariasis is a parasitic zoonosis caused by larvae of Toxocara canis or Toxocara cati. These nematodes normally live in the small intestine of domestic dogs and cats, their deﬁnitive hosts. Most human infections are thought to be subclinical or self-limited, and clinical infections usually aﬀect young children and manifest most commonly with pulmonary or hepatic disease. Clinical involvement of the central nervous system is rare and probably occurs as a result of hematogenous dissemination [1, 2]. 2. Case Report A previously healthy 45-year-old farmer presented at the emergency department with a tingling sensation and weak- ness in the lower limbs. The symptoms started 1 week earlier and were gradually progressive. He also noticed diﬃculty with micturition since the past few days. He did not have upper limb complaints nor back pain, and he denied any recent back trauma, infection, or vaccination. He had not been in foreign countries. On clinical examination, there was a symmetrical paresis of the lower limbs (global grade 4/5 on MRC scale, though the proximal muscle groups being slightly weaker), with a sensory loss of all modalities below thoracic dermatome level 10, brisk deep tendon reﬂexes in the lower limbs, and bilateral Babinski signs. Over the next 2 days, his case deteriorated into paraplegia with anaesthesia in the lower limbs and total loss of control of bladder and bowel. Spinal MRI showed an intramedullary T2-weighted hyperintensity extending from thoracic level 4 to 10 with- out contrast enhancement (Figure 1). Brain MRI showed multiple T2-weighted hyperintense lesions, the largest lying posterior to the left lateral ventricle (Figures 2 and 3). The supratentorial lesions showed contrast enhancement (Figure 4), the one in the pons did not. Examination of cerebrospinal ﬂuid (CSF) revealed 25 leukocytes/µL with 87% lymphocytes, 9% eosinophils, 33 mg/dL of protein, and 62 mg/dL of glucose; IgG index was normal (0.62); there were no oligoclonal IgG bands. The relative amount of peripheral blood eosinophils was increased to 21% with the total white blood cell count being normal (8.300/mm3). C- reactive protein and routine biochemical blood tests were all normal. Ophthalmologic examination was normal, as were thoracic and abdominal CT scans. Treatment was started with intravenous methylprednisolone (1 g q24h for 5 days). The presence of eosinophils in the blood and CSF suggested a parasitic infection, and therefore oral mebendazole (200 mg q12h) was added. Antibody titer against Toxocara canis using ELISA (for excretory-secretory antigen) was 1 : 500 positive in blood and 1 : 32 positive in cerebrospinal ﬂuid. A broad screening for other neurotropic infections (including Taenia)