Images in clinical rheumatology
Lumbar myositis associated with Toxocara spp. infection
Miositis lumbar asociada a infección por Toxocara spp
Anne-Pauline Bellangera,b,
, Michel Rungec, Daniel Wendlingd, Philippe Humberte,f
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a Department of Parasitology-Mycology, University Hospital, Besançon, France
b CNRS-University of Franche-Comte/UMR 6249 Chrono-environnement, Besançon, France
c Department of Radiology, University Hospital, Besançon, France
d Department of Rheumatology, University Hospital, Besançon, France
e Department of Dermatology, University Hospital, Besançon, France
f SFR FED 4234 IBCT Cell and Tissue Engineering and Biology, INSERM U 1098_University of Franche-Comte, Besançon, France
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"CNRS-University of Franche-Comte/UMR 6249 Chrono-environnement, Besançon, France" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Radiology, University Hospital, Besançon, France" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Rheumatology, University Hospital, Besançon, France" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Dermatology, University Hospital, Besançon, France" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "SFR FED 4234 IBCT Cell and Tissue Engineering and Biology, INSERM U 1098_University of Franche-Comte, Besançon, France" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miositis lumbar asociada a infección por <span class="elsevierStyleItalic">Toxocara</span> spp" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 850 "Ancho" => 2503 "Tamanyo" => 130860 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial and coronal planes of the patient's MRI, both showing T2-Fat saturation high signals in intramuscular structures. (A) Axial plane. (B) Coronal plane.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 67-year-old male patient presented with acute thoraco lumbar and right trochanteric pain at the consultation of Rheumatology. The patient could not sleep due to the pain, mostly localized in the right iliac crest but irradiating to the trochanter. Pain was aggravated by pressure, right side-lying and seating postures. Magnetic resonance imaging of the spine revealed a lumbar myositis, with T2 high signals in the paraspinal muscles (L3–L4 area) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no cutaneous eruption, no neck stiffness, no biologic inflammatory syndrome, no biologic sign of muscular lysis and no hypereosinophilia. Results of immunological investigations including complement fractions explorations, rheumatoid factor dosage and cryoglobulins detection, were negative. Results of serum antibody tests for <span class="elsevierStyleItalic">Borrelia burgdorferi</span>, <span class="elsevierStyleItalic">Coxiella burnetti</span> and <span class="elsevierStyleItalic">Treponema pallidum</span> were also negative. In contrast, the <span class="elsevierStyleItalic">Toxocara canis</span> serologic tests were strongly positive by both <span class="elsevierStyleItalic">Toxocara</span> enzyme-linked Immunosorbent assay and <span class="elsevierStyleItalic">Toxocara</span> Western blot assays. The patient did not have a dog but was living in a rural area and reported frequent contacts with soil. Pains disappeared rapidly after 4 days of albendazole treatment. Six months later, the patients relapsed with similar symptoms in intensity and location; the pains disappeared again after 4 days of albendazole treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Human toxocariasis is a widespread soil-transmitted parasitic disease. Principal risk factors include contact with dogs and soil and residence in a rural region.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> After ingestion <span class="elsevierStyleItalic">Toxocara</span> spp. embryonated eggs hatch in the intestines and the larvae migrate via the blood circulation to the liver, lungs and left heart, from where they disseminate via the systemic circulation to eyes, brain or muscles.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a><span class="elsevierStyleItalic">Toxocara</span> spp. infections are highly pleiomorphic, depending on the number and location of encysted larvae in the body and the immune sensitivity of the host.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Definitive diagnosis of toxocariasis would require identification of larvae in human tissues such as skin biopsies, but this is rarely achieved. Besides, as <span class="elsevierStyleItalic">Toxocara</span> spp. infection is a parasitological dead-end, neither adult roundworms nor eggs can be found in stools to make a direct diagnosis. Consequently, the diagnosis is usually made on the basis of serologic tests results. Two types of tests are available for the immunodiagnosis of toxocariasis: the ELISA and Western blot (WB), both using <span class="elsevierStyleItalic">T. canis</span> excretory-secretory antigens (TES). WB is the more sensitive and specific of the two assays.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Amongst all available drugs, albendazole, is the most commonly used and treatment of choice because its reaches higher serum levels, is well-tolerated and better absorbed outside the gastronintestinal tract.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> Repeated courses of anthelmintic treatments may be necessary to eliminate definitely the symptoms.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Pharmacological treatment must be accompanied by prevention of recontamination by deworming dogs and sanitary education.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 850 "Ancho" => 2503 "Tamanyo" => 130860 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial and coronal planes of the patient's MRI, both showing T2-Fat saturation high signals in intramuscular structures. (A) Axial plane. (B) Coronal plane.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Highlights of human toxocariasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.F. Magnaval" 1 => "L.T. Glickman" 2 => "P. Dorchies" 3 => "B. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 14 | 21 |
| 2024 Octubre | 46 | 44 | 90 |
| 2024 Septiembre | 60 | 21 | 81 |
| 2024 Agosto | 73 | 34 | 107 |
| 2024 Julio | 49 | 31 | 80 |
| 2024 Junio | 81 | 37 | 118 |
| 2024 Mayo | 68 | 39 | 107 |
| 2024 Abril | 41 | 32 | 73 |
| 2024 Marzo | 64 | 38 | 102 |
| 2024 Febrero | 36 | 26 | 62 |
| 2024 Enero | 37 | 51 | 88 |
| 2023 Diciembre | 47 | 24 | 71 |
| 2023 Noviembre | 47 | 25 | 72 |
| 2023 Octubre | 39 | 25 | 64 |
| 2023 Septiembre | 89 | 41 | 130 |
| 2023 Agosto | 40 | 16 | 56 |
| 2023 Julio | 66 | 30 | 96 |
| 2023 Junio | 55 | 29 | 84 |
| 2023 Mayo | 66 | 29 | 95 |
| 2023 Abril | 49 | 12 | 61 |
| 2023 Marzo | 63 | 34 | 97 |
| 2023 Febrero | 86 | 38 | 124 |
| 2023 Enero | 58 | 29 | 87 |
| 2022 Diciembre | 74 | 34 | 108 |
| 2022 Noviembre | 89 | 42 | 131 |
| 2022 Octubre | 91 | 33 | 124 |
| 2022 Septiembre | 69 | 33 | 102 |
| 2022 Agosto | 79 | 48 | 127 |
| 2022 Julio | 57 | 58 | 115 |
| 2022 Junio | 57 | 34 | 91 |
| 2022 Mayo | 72 | 44 | 116 |
| 2022 Abril | 85 | 64 | 149 |
| 2022 Marzo | 86 | 53 | 139 |
| 2022 Febrero | 64 | 33 | 97 |
| 2022 Enero | 84 | 42 | 126 |
| 2021 Diciembre | 59 | 42 | 101 |
| 2021 Noviembre | 44 | 52 | 96 |
| 2021 Octubre | 87 | 48 | 135 |
| 2021 Septiembre | 65 | 44 | 109 |
| 2021 Agosto | 48 | 46 | 94 |
| 2021 Julio | 111 | 47 | 158 |
| 2021 Junio | 127 | 38 | 165 |
| 2021 Mayo | 168 | 35 | 203 |
| 2021 Abril | 238 | 56 | 294 |
| 2021 Marzo | 91 | 57 | 148 |
| 2021 Febrero | 65 | 36 | 101 |
| 2021 Enero | 59 | 26 | 85 |
| 2020 Diciembre | 53 | 19 | 72 |
| 2020 Noviembre | 46 | 23 | 69 |
| 2020 Octubre | 43 | 19 | 62 |
| 2020 Septiembre | 52 | 30 | 82 |
| 2020 Agosto | 47 | 17 | 64 |
| 2020 Julio | 41 | 19 | 60 |
| 2020 Junio | 45 | 29 | 74 |
| 2020 Mayo | 49 | 18 | 67 |
| 2020 Abril | 35 | 24 | 59 |
| 2020 Marzo | 41 | 21 | 62 |
| 2020 Febrero | 55 | 19 | 74 |
| 2020 Enero | 66 | 22 | 88 |
| 2019 Diciembre | 45 | 28 | 73 |
| 2019 Noviembre | 51 | 20 | 71 |
| 2019 Octubre | 63 | 24 | 87 |
| 2019 Septiembre | 45 | 25 | 70 |
| 2019 Agosto | 50 | 32 | 82 |
| 2019 Julio | 52 | 27 | 79 |
| 2019 Junio | 54 | 24 | 78 |
| 2019 Mayo | 84 | 50 | 134 |
| 2019 Abril | 51 | 67 | 118 |
| 2019 Marzo | 54 | 29 | 83 |
| 2019 Febrero | 50 | 33 | 83 |
| 2019 Enero | 53 | 29 | 82 |
| 2018 Diciembre | 97 | 59 | 156 |
| 2018 Noviembre | 88 | 10 | 98 |
| 2018 Octubre | 66 | 12 | 78 |
| 2018 Septiembre | 37 | 11 | 48 |
| 2018 Agosto | 37 | 10 | 47 |
| 2018 Julio | 17 | 6 | 23 |
| 2018 Mayo | 3 | 1 | 4 |
| 2018 Abril | 57 | 5 | 62 |
| 2018 Marzo | 65 | 11 | 76 |
| 2018 Febrero | 43 | 4 | 47 |
| 2018 Enero | 39 | 4 | 43 |
| 2017 Diciembre | 45 | 8 | 53 |
| 2017 Noviembre | 46 | 9 | 55 |
| 2017 Octubre | 29 | 13 | 42 |
| 2017 Septiembre | 33 | 6 | 39 |
| 2017 Agosto | 36 | 11 | 47 |
| 2017 Julio | 30 | 16 | 46 |
| 2017 Junio | 46 | 7 | 53 |
| 2017 Mayo | 60 | 8 | 68 |
| 2017 Abril | 46 | 6 | 52 |
| 2017 Marzo | 33 | 10 | 43 |
| 2017 Febrero | 31 | 4 | 35 |
| 2017 Enero | 39 | 8 | 47 |
| 2016 Diciembre | 60 | 14 | 74 |
| 2016 Noviembre | 72 | 8 | 80 |
| 2016 Octubre | 94 | 13 | 107 |
| 2016 Septiembre | 68 | 8 | 76 |
| 2016 Agosto | 25 | 12 | 37 |
| 2016 Julio | 16 | 5 | 21 |
| 2016 Junio | 0 | 13 | 13 |
| 2016 Mayo | 1 | 11 | 12 |
| 2016 Abril | 0 | 8 | 8 |
| 2016 Marzo | 0 | 12 | 12 |
| 2016 Enero | 0 | 15 | 15 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Septiembre | 1 | 0 | 1 |
| 2015 Agosto | 2 | 0 | 2 |
| 2015 Julio | 12 | 6 | 18 |
| 2015 Junio | 42 | 9 | 51 |
| 2015 Mayo | 42 | 17 | 59 |
| 2015 Abril | 35 | 12 | 47 |
| 2015 Marzo | 52 | 12 | 64 |
| 2015 Febrero | 49 | 2 | 51 |
| 2015 Enero | 39 | 0 | 39 |
| 2014 Diciembre | 51 | 0 | 51 |
| 2014 Noviembre | 54 | 0 | 54 |
| 2014 Octubre | 53 | 0 | 53 |
| 2014 Septiembre | 43 | 0 | 43 |
| 2014 Agosto | 47 | 0 | 47 |
| 2014 Julio | 52 | 0 | 52 |
| 2014 Junio | 52 | 0 | 52 |
| 2014 Mayo | 78 | 0 | 78 |
| 2014 Abril | 71 | 0 | 71 |
| 2014 Marzo | 88 | 38 | 126 |
| 2014 Febrero | 109 | 58 | 167 |
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