Encephalopathy due to visceral larva migrans.

For some time a syndrome of massive eosino-philia associated with respiratory and other symptoms has been recognized. The condition carries on the whole a good prognosis, is self-limiting and is most commonly seen in children, often occurring in several members of the same family. Frequently observed in the tropics or the subtropics, it has been variously described as Loeffler's syndrome, tropical eosinophilia, familial eosinophilia, or benign eosino-philic leukaemia. In 1940 this syndrome was shown to be associated with multiple eosinophilic granu-lomata in the liver, and in 1950, Mercer and his colleagues (Mercer, Lund, Bloomfield, and Caldwell, 1950) found that with this eosinophilia, Nematode larvae were sometimes to be seen in the tissues. suggested that the syndrome resulted from infection in man by a Nematode normally parasitic upon a lower animal; under these conditions the normal Nematode life cycle does not take place but is blocked by an eosinophilic granulomatous reaction at the stage where the larvae are in the tissues. At this point systemic symptoms and signs may appear, in addition to an eosinophilia, and it was for this stage that they coined the term 'visceral larva migrans'. The condition has been reported most frequently from the more southern states of the U.S.A. and in addition to the eosinophilia, the clinical features include malaise, pyrexia, bronchitis, 'pneumonitis', enlargement of the liver (and less commonly the spleen), lymphadenopathy, skin rashes, and sub-cutaneous granulomata. In view of the wide distribution of the larvae in the viscera, it would be surprising if the brain were to escape and indeed, 1956, describing the necropsy findings in a child who suffered from this condition but had died from another illness, found five larvae per gram of wet brain tissue. Despite this, clinical involvement of the nervous system has rarely been reported. Reviewing 58 cases Lewis, Yadav, and Kern (1962) found mention of convulsions in but three patients, one in Britain (Dickson and Woodcock, 1959) and two in America (Milburn and Ernst, 1953), while Moore (1962) described a further example which presented with convulsions and encephalitis. For an adult to be affected is equally rare and Lorentz (1962), who made the diagnosis in a West Indian immigrant in London, could find but three examples in the literature, and none in an English-born individual. In 1964, Brain and Allan described the case of a young Englishwoman who had visceral larva migrans presenting essentially the picture of varying …