toxocariasis is a parasitic infection caused by infection with the roundworm species toxocara canis or less frequently toxocara cati whose hosts are dogs and cats , respectively . humans become infected accidentally by ingestion of embryonated eggs from contaminated soil or dirty hands , or by ingestion of raw organs containing encapsulated larvae . keeping dogs and ingestion of raw cow liver a cross - sectional study of korean patients reported that a recent history of eating raw cow liver was associated with an increased risk of toxocariasis . clinical manifestation range from asymptomatic infection to fulminant disease , and the lungs , livers , and eyes are the most commonly involved organs . central nervous system ( cns ) involvement is relatively rare in toxocariasis , especially cns presenting as multiple cerebral infarction . we report a case of multiple cerebral infarction with lung and liver involvement due to t. canis infection in a previously healthy patient who was admitted for right leg weakness . a 39-year - old right - handed man with no significant past medical history was admitted to the hospital with a 3-day history of right leg weakness . he had undergone discectomy for herniated nucleus pulposus at the l5-s1 level 8 years prior and had not experienced any complications . he had no recent history of contact with pet animals and no past medical history of allergy . on admission , his blood pressure was 120/80 mmhg , his pulse was regular at 88 beats per minute , and his temperature was 36.8. there were neither audible carotid bruits nor cardiac murmurs . laboratory data were as follows : hemoglobin , 14.5 g / dl ; platelets , 160,000/mm ; aspartate aminotransferase , 37 iu / l ; alanine aminotransferase , 20 iu / l ; alkaline phosphatase , 61 iu / l ; creatinine 0.7 mg / dl ; c - reactive protein , 32.8 mg / l ; and erythrocyte sedimentation rate , 38 mm / h . the venereal disease research laboratory ( vdrl ) test and human immunodeficiency virus ( hiv ) antibody test in serum were negative . electrocardiogram showed normal sinus rhythm and transthoracic echocardiogram showed no evidence of mural thrombi or vegetations . diffusion - weighted brain mri revealed multifocal small embolic acute infarctions in the internal border zone of both cerebral hemispheres , temporooccipital lobes of both pca territory , and left cerebellar hemisphere ( fig . chest ct showed multiple peripheral ground glass opacities in both lungs that were considered eosinophilic pneumonia ( fig . 2 ) . abdominal ct on portal phase showed small ill - defined hypodense lesions in both lobes of the liver that were considered eosinophilic infiltrations ( fig . his csf contained 0/mm wbc , 63 mg / dl protein , and 49 mg / dl sugar ; no bacteria or viruses were detected . because he had marked eosinophilia and multiple eosinophilic infiltrations in both lungs and liver , serologic testing for parasitic infections was performed . serologic test result ( performed at seoul clnical laboratory ( scl ) , seoul , korea ) for t. canis igg antibody via enzyme - linked immunosorbent assay ( elisa , bordier affinity products sa , crissier , switzerland ) was positive with an antibody titer of 3.12 ( reference range < 1.00 ) . results of serologic tests for other helminthes ( cysticercus , paragonimus westermani , clonorchis sinensis sparaganum , entamoeba histolytica ) were all negative . any larva was not found in the csf and csf elisa assay for t. canis igg antibody was negative . while biopsy could be performed to find toxocara larva in the affected tissue and confirm the diagnosis , toxocariasis is usually diagnosed based on a combination of clinical symptoms , exposure history , marked eosinophilia , characteristic imaging findings and positive toxocariasis elisa results . thus , the patient was diagnosed with multiple cerebral infarction and concurrent multi - organ involvement due to t. canis infection without tissue biopsy . he was treated with albendazole ( 400 mg twice daily for 2 weeks ) and steroid ( prednisolone 30 mg twice daily for 7 days ) . two months after treatment , the follow - up tests including ct scan and brain mri were planned but the patient did n't visit our hospital . this disease occurs in developed countries as well as in the tropics and sub - tropics where dog treatment and population control are limited . human infection occurs by ingestion of embryonated eggs in contaminated soil or on unwashed hands , therefore high exposure to dogs and cats and contaminated soil are associated with toxocariasis . occasionally , toxocariasis is caused by consumption of raw liver and meat contaminated with larvae of t. canis . in south korea , chops of raw cow liver and meat are popular dishes and are thought to have health benefits ; toxocariasis , including subclinical toxocariasis , is therefore prevalent in south korea . we report here a case of toxocariasis presenting as multiple embolic infarction with concurrent visceral migrans involving the lungs and liver . the patient frequently consumed raw cow liver and meat , and this was likely the source of infection . toxocara can infect any organ , but is commonly recognized in the lungs , liver , and eyes . although t. canis can cross the blood - brain barrier , cns infection is rarely reported , but epilepsy , eosinophilic meningitis , meningo - encephalitis , encephalitis , arachnoiditis , vasculitis , meningo - myelitis , meningo - radiculitis , and optic neuritis due to toxocara infection have been reported . until recently , however , there has only been a few report of cerebral infarction due to toxocariasis . toxocara larvae are metabolically active and produce an array of enzymes and waste products that cause tissue damage , necrosis , and a marked inflammatory reaction , with eosinophils as the major component . the mechanism of cerebral infarction is not well known in toxocariasis , but could be derived from direct invasion of larva particles and secondary hypereosinophilia . larva particles can accidentally invade the brain parenchyme or block cerebral vessels , similar to microemboli . in hypereosinophilia , eosinophils could induce mural thrombus in the left ventricle or endomyocardial fibrosis by infiltrating the endocardium . a definitive diagnosis of toxocariasis is based on finding larvae in the affected tissue by histologic examination . clinically , the diagnosis is based on medical history , clinical presentation , eosinophilia in the serum , and/or high serum titer of t. canis antibodies as assessed by elisa or western blotting . our patient had multiple cerebral infarctions concurrent with visceral migrans on ct , hypereosinophilia , positive serology for t. canis igg , and a history of frequently eating raw cow liver and meat . he had no risk factors for multiple cerebral infarction and no cerebral vessel stenosis on cerebral ct angiography . there is no proven effective therapy for patients with neurotoxocariasis due to the rarity of the disease . albendazole is the most commonly used drug as it can penetrate the cerebrospinal fluid and has acceptable toxicity . concurrent administration of corticosteroids has been used to suppress intense allergic responses . in some studies , corticosteroids were effective at relieving serious neurologic symptoms brought on by an intensive inflammatory response   and increased plasma levels of albendazole by approximately 50% . because ingestion of uncooked cow liver and meat in south korea is common , toxocariasis is prevalent . this infection has various clinical manifestations including asymptomatic eosinophilia and eosinophilic infiltration of the lungs , liver , and eyes . central nervous system ( cns ) involvement is relatively rare in toxocariasis , especially cns presenting as multiple cerebral infarction . however , physicians should consider that cerebral infartion could occur simultaneously to the patient with toxocariasis .
toxocariasis is a parasitic infection caused by the roundworms toxocara canis or toxocara cati , mostly due to accidental ingestion of embryonated eggs . 
 clinical manifestations vary and are classified as visceral larva migrans or ocular larva migrans according to the organs affected . 
 central nervous system involvement is an unusual complication . here 
 , we report a case of multiple cerebral infarction and concurrent multi - organ involvement due to t. canis infestation of a previous healthy 39-year - old male who was admitted for right leg weakness . 
 after treatment with albendazole , the patient 's clinical and laboratory results improved markedly .