The Korean Journal of Medicine

  • 제84권6호
  • /
  • Pages.836-841
  • /
  • 2013
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

개회충증에 의하여 유발된 호산구성 심장막염을 동반한 급성 담낭염 1예

A Case of Acute Cholecystitis Combined with Eosinophilic Pericarditis Caused by Toxocariasis

  • 추진우 (순천향대학교 의과대학 내과학교실) ;
  • 최현종 (순천향대학교 의과대학 내과학교실) ;
  • 문종호 (순천향대학교 의과대학 내과학교실) ;
  • 정종호 (순천향대학교 의과대학 내과학교실) ;
  • 박진석 (순천향대학교 의과대학 내과학교실) ;
  • 명유식 (순천향대학교 의과대학 내과학교실) ;
  • 서혜선 (순천향대학교 의과대학 내과학교실)
  • Choo, Jin Woo (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Choi, Hyun Jong (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Moon, Jong Ho (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Chung, Jong Ho (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Park, Jin Seok (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Myung, Yu Sik (Department of Internal Medicine, Soonchunhyang University College of Medicine) ;
  • Seo, Hye Sun (Department of Internal Medicine, Soonchunhyang University College of Medicine)
  • 투고 : 2012.02.25
  • 심사 : 2012.07.02
  • 발행 : 2013.06.01
⟨ 이전 논문 다음 논문 ⟩

초록

개회충증 감염은 동물에 의해 토양으로 배설된 충란이나 유충이 경구로 섭취되거나 유충에 감염된 숙주의 내장을 직접 날것으로 먹었을 때 감염되며 충란이 장내에서 유충으로 부화하고 장벽을 침윤하여 순환하는 혈액을 따라 내장기관을 침범하고 염증반응을 일으키면서 임상적 증상을 유발한다. 본 증례는 심장막염이 동반된 급성 담낭염 환자로 호산구증가증이 동반되어 기생충 감염을 의심할 수 있었지만, 일반적인 분변 검사를 통해 원인 감별이 어려웠고, ELISA를 통한 면역혈청학적 검사를 통해 개회충증을 진단하고 치료 후 임상적인 호전을 보였다. 개회충증으로 인한 호산구증가증과 관련하여 급성 담낭염 및 심막염이 발생한 드문 증례로 문헌고찰과 함께 보고하는 바이다.

Toxocariasis is a parasite infection of a human host caused by Toxocara canis. Most human infections occur in persons who eat contaminated food containing embryonated eggs or larvae. Toxocariasis can produce various symptoms associated with eosinophilic infiltration into various internal organs such as the liver, lungs, eyes, or central nervous system. However, a simultaneous onset of cholecystitis and pericarditis has not yet been reported in the literature. A 39-year-old female patient complained of right upper abdominal pain. Several imaging studies revealed acute cholecystitis and pericarditis with pericardial effusion. Marked eosinophilia was observed in her peripheral blood and pericardial fluid. A high titer of antibodies against T. canis was discovered during the search for the cause of the eosinophilia. All clinical features and the eosinophilia improved dramatically after treatment with albendazole. We report a case of simultaneous onset of acute cholecystitis and pericarditis associated with marked eosinophilia caused by T. canis.

키워드

참고문헌

  1. Magnaval JF, Glickman LT, Dorchies P, Morassin B. Highlights of human toxocariasis. Korean J Parasitol 2001;39:1-11. https://doi.org/10.3347/kjp.2001.39.1.1
  2. Despommier D. Toxocariasis: clinical aspects, epidemiology, medical ecology, and molecular aspects. Clin Microbiol Rev 2003;16:265-272. https://doi.org/10.1128/CMR.16.2.265-272.2003
  3. Han SS, Kim WJ, Lee SJ, Cho BR, Lee SW. A case of eosinophilic pleural effusion who was serologically positive for both Paragonimus westermani and Toxocara canis. Korean J Med 2004;67:650-654.
  4. Sturchler D, Schubarth P, Gualzata M, Gottstein B, Oettli A. Thiabendazole vs. albendazole in treatment of toxocariasis: a clinical trial. Ann Trop Med Parasitol 1989;83:473-478. https://doi.org/10.1080/00034983.1989.11812374
  5. Rothenberg ME, Hogan SP. The eosinophil. Annu Rev Immunol 2006;24:147-174. https://doi.org/10.1146/annurev.immunol.24.021605.090720
  6. Leder K, Weller PF. Eosinophilia and helminthic infections. Baillieres Best Pract Res Clin Haematol 2000;13:301-317. https://doi.org/10.1053/beha.1999.0074
  7. Schantz PM, Glickman LT. Toxocaral visceral larva migrans. N Engl J Med 1978;298:436-439. https://doi.org/10.1056/NEJM197802232980806
  8. Rubinsky-Elefant G, Hirata CE, Yamamoto JH, Ferreira MU. Human toxocariasis: diagnosis, worldwide seroprevalences and clinical expression of the systemic and ocular forms. Ann Trop Med Parasitol 2010;104:3-23. https://doi.org/10.1179/136485910X12607012373957
  9. Park HY, Lee SU, Huh S, Kong Y, Magnaval JF. A seroepidemiological survey for toxocariasis in apparently healthy residents in Gangwon-do, Korea. Korean J Parasitol 2002;40:113-117. https://doi.org/10.3347/kjp.2002.40.3.113
  10. Kwon NH, Oh MJ, Lee SP, Lee BJ, Choi DC. The clinical impact of toxocariasis in patients with unknown eosinophilia. Korean J Asthma Allergy Clin Immunol 2005;25: 299-304.
  11. Fox H, Mainwaring AR. Eosinophilic infiltration of the gallbladder. Gastroenterology 1972;63:1049-1052.
  12. Felman RH, Sutherland DB, Conklin JL, Mitros FA. Eosinophilic cholecystitis, appendiceal inflammation, pericarditis, and cephalosporin-associated eosinophilia. Dig Dis Sci 1994; 39:418-422. https://doi.org/10.1007/BF02090217
  13. Rosengart TK, Rotterdam H, Ranson JH. Eosinophilic cholangitis: a self-limited cause of extrahepatic biliary obstruction. Am J Gastroenterol 1990;85:582-585.
  14. Kaji K, Yoshiji H, Yoshikawa M, et al. Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: a case report. World J Gastroenterol 2007;13: 3760-3762. https://doi.org/10.3748/wjg.v13.i27.3760
  15. Kim YH. Eosinophilic cholecystitis in association with clonorchis sinensis infestation in the common bile duct. Clin Radiol 1999;54:552-554. https://doi.org/10.1016/S0009-9260(99)90855-3
  16. Russell CO, Dowling JP, Marshall RD. Acute eosinophilic cholecystitis in association with hepatic echinococcosis. Gastroenterology 1979;77:758-760.