Baylisascaris procyonis and Herpes Simplex Virus 2 Coinfection Presenting as Ocular Larva Migrans with Granuloma Formation in a Child

• Published in: The American journal of tropical medicine and hygiene Vol. 93; no. 3; pp. 612 - 614
• Main Authors: Liu, Grace, Fennelly, Glenn, Kazacos, Kevin R, Grose, Charles, Dobroszycki, Joanna, Saffra, Norman, Coyle, Christina M, Weiss, Louis M, Szlechter, Moshe M, Tanowitz, Herbert B
• Format: Journal Article
• Language: English
• Published: United States The American Society of Tropical Medicine and Hygiene 01.09.2015
• Series: Case Report
• Subjects: Animals; Ascaridida Infections - complications; Ascaridida Infections - diagnosis; Ascaridoidea; Child; Coinfection; Diagnosis, Differential; Eye Infections, Parasitic - complications; Eye Infections, Parasitic - diagnosis; Female; Fundus Oculi; Granuloma - diagnosis; Granuloma - etiology; Granuloma - parasitology; Granuloma - virology; Herpes simplex virus 2; Herpesviridae; Herpesvirus 2, Human; Humans; Keratitis, Herpetic - complications; Keratitis, Herpetic - diagnosis; Keratitis, Herpetic - virology; Larva Migrans - diagnosis; ANW, USA, New York, New York City
• ISSN: 0002-9637; 1476-1645
• DOI: 10.4269/ajtmh.15-0272

Ocular Baylisascaris procyonis infection results from ingestion of infective eggs of B. procyonis, the raccoon ascarid. Herpes simplex virus type 2 (HSV-2) infection of the retina is the result of either primary infection or reactivated disease. Herein, we report a case of a 12-year-old female resident of the Bronx in New York City, who presented with pan-uveitis and vision loss. Initial evaluation for etiologic causes was nondiagnostic. Serology for anti-Baylisascaris procyonis antibodies in serum and vitreous fluid were both positive. Polymerase chain reaction (PCR) of vitreous fluid was positive for HSV-2. Treatment with vitrectomy, albendazole, and acyclovir resulted in mild improvement of visual acuity. The atypical presentation of B. procyonis in this case, as ocular larva migrans with a peripheral granuloma and retinal detachment, underscores the importance of maintaining a high degree of suspicion for this pathogen even in non-diffuse unilateral subacute neuroretinitis (DUSN) patients in urban areas. This case further illustrates that it is possible to have coexisting infections in cases of posterior uveitis.