Visceral larva migrans presenting as acute abdomen in a child Mustafa Inan a, * , Nermin Sakru b , Ulfet Vatansever c , Selcuk Bilgi d a Department of Pediatric Surgery, Faculty of Medicine, University of Trakya, 22030 Edirne, Turkey b Department of Microbiology and Clinical Biology, Faculty of Medicine, University of Trakya, 22030 Edirne, Turkey c Department of Paediatrics, Faculty of Medicine, University of Trakya, 22030 Edirne, Turkey d Department of Pathology, Faculty of Medicine, University of Trakya, 22030 Edirne, Turkey Abstract An unusual presentation of visceral larva migrans observed in a patient is reported. A 5-year- old boy suffering fever, abdominal pain, tenderness, and rigidity in the right lower and upper quadrant of the abdomen was operated on, with the false diagnosis of acute abdomen, and exploratory surgery was carried out. The pathological examination of the liver biopsy revealed eosinophil-rich necrotizing granulomatous inflammation with Toxocara spp larva. The diagnosis was also confirmed by serologic results. Clinicians should remember that toxocaral visceral larva migrans may rarely mimic an acute abdomen and cause unnecessary operations. D 2006 Elsevier Inc. All rights reserved. Toxocara canis and T cati are distributed worldwide, and the degree of host damage and the concomitant elicitation of signs and symptoms vary with regard to which tissue has been invaded: the liver, lungs, or central nervous system [1]. Human toxocariasis is manifested as 3 distinct entities. The first is visceral larva migrans (VLM), with typical presen- tation of fever, pulmonary manifestations, and hepatomeg- aly. The second one is ocular toxocariasis, and the last one is covert toxocariasis [2]. To our knowledge, acute abdomen table during the toxocaral VLM syndrome has not been published in the English literature [1-7]. We would like to report a patient who had toxocaral VLM mimicking acute appendicitis and discuss its clinical features. 1. Case report A 5-year-old boy presented to the emergency department (ED) with a primary complaint of abdominal pain and fever for a 2-day duration. Initially, the pain was dull, constant, and perceived in the midepigastrium. The pain did not respond to a dose of acetaminophen taken 2 days earlier at the onset of his pain. Over the course of 24 hours, the pain became sharp and colicky and had localized to the right lower quadrant. The worsening pain was associated with 2 episodes of nonbloody, nonmucous diarrhea and anorexia. His history was significant for upper airway infection over the last week. He had been given antibiotic (unknown name) and metimazol (antipyretic) and had experienced urticaria after 4 days. He was admitted to another hospital and was diagnosed to have lower airway infection and urticaria due to metimizol. He had been given acetaminophen, claritro- mycin, corticosteroids, and antihistaminics, which partially improved his symptoms. He was transported to our ED 0022-3468/$ – see front matter D 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2005.11.081 * Corresponding author. Trakya Universitesi Tip Fakqltesi, C ¸ ocuk Cerrahisi AD, 22030, Edirne-Turkey. Tel.: +90 284 235 7641 1094, GSM: +90 505 527 13 89; fax: +90 284 235 76 52. E-mail address: mustafainan@trakya.edu.tr (M. Inan). Index words: Visceral larva migrans; Toxocariasis; Acute abdomen; Toxocara canis Journal of Pediatric Surgery (2006) 41, E7–E9 www.elsevier.com/locate/jpedsurg