We started oral administration of prednisolone 1 mg/kg for 3 days and performed ventricular endomyocardial biopsy. Histopathologic findings revealed myocyte necrosis and degeneration (Fig. 3). The antibody test against parasitic infection demonstrated that toxocara immunoglobulin G (IgG) was

positive. Taken together, we diagnosed Inhibitors,research,lifescience,medical that she had myocarditis caused by T. canis VLM. We started oral administration of albendazol 400 mg twice a day for two weeks after oral prednisolone 1 mg/kg administration for 3 days. Three days after starting steroid therapy, eosinophil count decreased promptly (130/mm3). One week after steroid therapy, TTE was followed up. TTE finding showed that echogenicity of LV myocardium was markedly decreased and wall thickness was normalized (Fig. 2C). M mode evaluation of LV showed completely recovered myocardial contractility (Fig. 2D). After the completion of the treatment, physical examination, AMPK activators review laboratory Inhibitors,research,lifescience,medical tests, ECG and echocardiogram showed no abnormal

findings and she was Inhibitors,research,lifescience,medical able to return to work. Fig. 1 Twelve-lead electrocardiogram reveals regular sinus rhythm with low voltage. Fig. 2 Transthoracic echocardiogram (TTE). A: Parasternal long axis view of TTE showed edematous myocardium with increased echogenicity and small pericardial effusion. B: M-mode image of mid ventricular Inhibitors,research,lifescience,medical level of left ventricle showed decreased contractility. … Fig. 3 Myocardial biopsy microscopic finding (after three days of treatment with prednisolone) shows myocyte necrosis and degeneration [H&E stain, (A) × 100, (B) × 400]. ←: myocyte necrosis, ○: myocyte degeneration. Discussion Human toxocariasis is a helminthozoonosis due to the migration of Toxocara species larvae through human organism. Many reviews from Western countries indicated that children under 12 years old, who often play outside, are

the most affected age group for toxocariasis.1),2) They are accidentally infected with T. canis eggs, which expelled Inhibitors,research,lifescience,medical in feces puppies and fully develop in the surrounding environment within two to four weeks. Human become infected by ingesting either embryonated eggs isothipendyl from soil (geophagia, pica), dirty hands or raw vegetables, or larvae from undercooked giblets. When embryonated eggs of T. canis reach the human gastrointestinal tract, they hatch and enter the portal system, reaching the liver. Some larvae then migrate to the lungs and heart through the systemic circulation.3) In this case, we could not find obvious source for T. canis infection. She didn’t have any history of raising a dog or eating undercooked giblets. We assumed that she infected by ingesting embryonated eggs or larvae from raw vegetables, such as lettuce. A definitive laboratory diagnosis of human toxocaral infection can be achieved by pathology examination of various organ specimens.