Male school, eight years old, obese (BMI 20.1), with urban residence.
He had contact with a vaccinated pet (dog), but without periodic control.
She had a history of an episode of entero-parasitosis (Entamoeba coli) at 4 years of age, treated with mebendazole for three days, and had not taken any other medication immediately before.
A diagnosis of familial hypercholesterolemia was made based on clinical history.
The patient was admitted to the hospital emergency unit with acute postprandial epigastric abdominal pain, colic, associated with recurrent nausea for 15 days without fever, jaundice or choluria, acholia
The segmental physical examination only showed diffuse abdominal sensitivity with epigastric predominance, without visceromegaly.
He was admitted with a presumptive diagnosis of acute seizures.
Examinations revealed mild hypochromatic microcytic anemia, normal leukocyte count, absolute leukocyte count 2,189/mm3, normal platelets, and normal C-reactive protein.
Uremia, creatinine, glycaemia, proteinaemia, calcaemia, bilirubinaemia, mylasaemia, tranquilaminase oxa, normal serum triglycerides (GOT cholesterol, alkaline phosphatase)
Pyruvic transaminase (PTG) and gamma-glucyltransferase (GGT) slightly elevated/81).
Parasitological examination of stools and stool samples were negative.
Abdominal ultrasound showed a thickened gallbladder with 4.5 mm thick in diffuse, distended shape, without stones.
Computed axial tomography (CAT) of the abdomen and pelvis performed agreed with the findings described in ultrasound, also describing a perivesicular inflammation and slight dilation of the intrahepatic bile duct.
A cholangioresonance confirmed the tomogeneic signs and ruled out a choledochal cyst.
Symptoms and clinical signs, as well as those described above, were considered compatible with acute acalculous urticaria.
Searching for some infectious etiology serology requested: IgM for Epstein virus, hepatitis A, Bartonella henselae, toxoplasmosis, human hydatid disease, Fasciola hepatica and triqui negative.
Serology (IgM and IgG) for cytomegalovirus was positive.
Upper endoscopy showed mild nodular antropathy. Three samples were taken for polymerase chain reaction (PCR) for CMV in gastric tissue with negative results.
At the same time, the patient made a diagnosis of toxocarosis suspected, which was confirmed with IgG by ELISA (CO/DO 1.5) and Western blot (LDBIO Diagnostics) positive for Tocatis pigmentosa.
The patient was treated with ranitidine (3 mg/kg/day) evolving with decreased pain and nausea cessation; however, the day after discharge, at five days of observation, he was readmitted with equals.
After confirming the infection by Toxo spp., she was treated withbendazole 5 mg/kg per day for 15 days, with total regression of symptoms.
Two successive ultrasounds showed disappearance of the findings described in the first ultrasound.
Monthly outpatient or later bimonthly controls revealed recurrence of symptoms associated with oscillating values (1.83/mm3, 448, 833/mm3), so the last treatment was repeated with good clinical value.
