C69-17 Dyspnea With a Side of Dirt: A Rare Case of Pulmonary Toxocariasis

Abstract Toxocariasis is a zoonotic parasitic infection by larvae of primarily Toxocara canis and Toxocara cati. This parasite is transmitted to humans via ingestion of embryonated Toxocara eggs found in contaminated soil, water, or surfaces contaminated with animal feces. Although it typically manifests as visceral or ocular larva migrans, pulmonary involvement mimicking malignancy or granulomatous disease is rare. We report a case of pulmonary toxocariasis presenting as multiple pulmonary nodules in an adult female with pica. A 43-year-old female with history of asthma presented to the hospital with progressive dyspnea for two weeks. She also reported fever, body aches, and arthralgias during this time. She denies intravenous drug use or recent travel history, but on further inquiry, stated that she has been ingesting a cup of dirt daily for weeks at various construction sites. Her complete blood count was significant for a hemoglobin of 10 with MCV 73.3, and an absolute eosinophil count of 720. Her iron studies were significant for a, iron level of 24, ferritin of 27, and transferring saturation of 7%. CT of the chest was positive for several bilateral pulmonary nodules measuring up to 1.0 cm. Biopsy of one of her lung nodules revealed small fragments of lung alveolar tissue with few eosinophils and was negative for granulomata, fibrosis, malignancy, acid-fast organisms, and fungal organisms. Patient’s Toxocara antibody was highly positive at 54U. She was treated with albendazole 400mg twice a day for five days with rapid improvement in her symptoms, received intravenous iron supplementation, and was advised to continue outpatient treatment for her iron deficiency anemia. This case highlights the importance of considering parasitic infections in the differential diagnosis of pulmonary nodules, particularly in patients with unexplained eosinophilia. Toxocariasis can mimic neoplastic or granulomatous disease on imaging, and diagnosis requires clinical correlation with serologic testing. This case also emphasizes the importance of a comprehensive history in diagnosing pulmonary diseases, as the patient’s history of pica was crucial to this diagnosis, especially given that pulmonary involvement is an uncommon manifestation of Toxocariasis. Early recognition and treatment with albendazole can prevent complications and lead to full recovery. This abstract is funded by: None