Chronic polyarthritis as isolated manifestation of toxocariasis

Human toxocariasis is a parasitic zoonosis mainly caused by Toxocara canis or Toxocara cati and is acquired by ingestion of the parasite's embryonated eggs. Arthralgia and/or arthritis were reported in up to 17% of the cases, generally with acute duration (less than 6 weeks). However, to our knowledge, chronic polyarthritis, as the isolated presentation of Toxocara infection, was not reported. One of the 5809 patients that was followed up at our service (0.017%) had chronic polyarthritis as the single manifestation of toxocariasis and was described herein. A 3-year-old girl was referred to our service with severe painful chronic polyarthritis for a period longer than 10 weeks and morning stiffness of 30min. Dog contact exposure history in the recreational areas of neighborhood was reported. Her exams showed high levels of eosinophils in peripheral blood (29%), bone marrow aspirate revealed marked eosinophilia (32%) and Toxocara enzyme-linked immunosorbent assay (Elisa) was positive (1:1280). She was treated with paracetamol (40mg/kg/day) and thiabendazole (25mg/kg/day) for 10 days, and all manifestations reduced. After eight months of follow-up, she was on clinical and laboratorial remission. In conclusion, we described a case of chronic polyarthritis, as isolated manifestation of toxocariasis, mimicking juvenile idiopathic arthritis and leukemia. Importantly, this zoonosis should be considered in patients with arthritis and eosinophilia. A toxocaríase é uma zoonose parasitária causada principalmente pelo Toxocara canis ou pelo T. cati. É adquirida pela ingestão de ovos embrionados do parasita. A artralgia e/ou artrite foram relatadas em até 17% dos casos, geralmente com duração aguda (menos de seis semanas). No entanto, que se tem conhecimento, a poliartrite crônica como manifestação isolada da infecção por Toxocara ainda não foi descrita na literatura. Um dos 5.809 pacientes acompanhados em nosso serviço (0,017%) exibiu poliartrite crônica como manifestação única da toxocaríase e foi descrito neste estudo. Uma menina de três anos foi encaminhada ao nosso serviço com poliartrite crônica dolorosa grave por um período superior a 10 semanas e rigidez matinal diária de 30 minutos. Foi relatada história de exposição a contato com cão nas áreas de lazer do bairro. Seus exames revelaram níveis elevados de eosinófilos no sangue periférico (29%), o aspirado de medula óssea revelou eosinofilia acentuada (32%) e o ensaio imunoenzimático ligado a enzima (Elisa) para