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

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.

The usefulness of transient elastography, acoustic-radiation-force impulse elastography, and real-time elastography for the evaluation of liver fibrosis

BACKGROUND/AIMS: Several noninvasive methods have recently been developed for the evaluation of liver fibrosis. The accuracy of transient elastography (TE), acoustic-radiation-force impulse (ARFI) elastography, and real-time elastography (RTE) in predicting liver fibrosis were evaluated. METHODS: Seventy-four patients who had undergone a liver biopsy within the previous 6 months were submitted to evaluation with TE, ARFI, and RTE on the same day. RESULTS: There were significant correlations between fibrosis stage and liver stiffness measurement (LSM) using the three tested methods: TE, r2=0.272, P=0.0002; ARFI, r2=0.225, P=0.0017; and RTE, r2=0.228, P=0.0015. The areas under the receiver operating characteristic curves (AUROC) for the diagnosis of significant fibrosis (> or =F2, Metavir stage) by TE, ARFI, RTE, TE/platelet count (PLT), velocity of shear wave (Vs)/PLT, and elasticity score (Es)/PLT were 0.727, 0.715, 0.507, 0.876, 0.874, and 0.811, respectively. The AUROC for the diagnosis of cirrhosis by TE, ARFI, RTE, TE/PLT, Vs/PLT, and Es/PLT were 0.786, 0.807, 0.767, 0.836, 0.819, and 0.838, respectively. Comparisons of AUROC between all LSMs for predicting significant fibrosis (> or =F2) produced the following results: TE vs. RTE, P=0.0069; ARFI vs. RTE, P=0.0277; and TE vs. ARFI, P=0.8836. Applying PLT, the ability of each LSM to predict fibrosis stage significantly increased: TE/PLT vs. TE, P=0.0004; Vs/PLT vs. ARFI, P=0.0022; and Es/PLT vs. RTE, P<0.0001. However, the ability to predict cirrhosis was not enhanced, combining LSM and PLT. CONCLUSIONS: TE and ARFI may be better methods for predicting significant liver fibrosis than RTE. This predictive ability increased significantly when accounting for platelet count. However, all of the measures had comparable efficacies for predicting cirrhosis.