ECCHYMOSES –AN UNUSUAL MANIFESTATION OF TOXOCARIASIS IN CHILDREN

Lamabadusuriya SP¹, Wickramasinghe VP¹, Wijesundera M De S²

¹ Professorial Paediatric Unit, Lady Ridgeway Hospital, Colombo,

Sri Lanka.

² University of Peradeniya, Peradeniya, Sri Lanka

Objective: To investigate the cause of ecchymoses associated with eosinophilia.

Setting: Professorial Paediatric Unit (PPU) at Lady Ridgeway Hospital (LRH) for Children, Colombo, Sri Lanka.

Design: Prospective study from July 1998 to April 2000.

Materials and Methods: Patients admitted to the PPU with multiple ecchymoses associated with an absolute eosinophilia (>1000/mm³) were investigated further to determine the possible aetiology; bleeding time, clotting time, platelet count, platelet function tests, stool full report and toxocara antibody tests were performed. WBCDC, bleeding time and toxocara serology were repeated after treatment.

Results: Fourteen patients consisting of 11 boys and 3 girls were studied; 7 were between 1-5 yrs and 7 were >5yrs of age. The mean eosinophil count was 4300/mm³.

All patients had a prolonged bleeding time, mean value 9 minutes, but clotting time and platelet counts (mean value 220,000/mm³) were normal. Platelet function tests were done in 5(36%) patients and showed a similar pattern of dysfunction. Twelve patients were positive for toxocariasis and the other two were positive for ascariasis. Post treatment mean eosinophil count was 630/mm³ and the bleeding time was 4 minutes.

Conclusion: Visceral larva migrans could present with haemorrhagic manifestations due to an acquired bleeding disorder associated with platelet dysfunction. Awareness of the existence of such an entity would help to investigate, diagnose and treat this condition and lessen the anxiety.

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