D1.397 - Eosinophilic Pneumonia Triggered by Toxocara canis in a Patient with Kartagener Syndrome: A Case Report Highlighting Diagnostic Challenges and Interdisciplinary Management

Kartagener syndrome, a subtype of primary ciliary dyskinesia (PCD), is characterized by situs inversus, bronchiectasis, and chronic sinusitis, predisposing patients to recurrent respiratory infections due to impaired mucociliary clearance. This case report details a 24-year-old woman with Kartagener syndrome who developed eosinophilic pneumonia caused by Toxocara canis, a rare parasitic infection that less commonly affects the lungs. Her medical history included situs inversus, multiple respiratory infections requiring surgical interventions, and hypertension. During her first hospitalization, symptoms such as pleural effusion and persistent cough were misdiagnosed as bacterial pneumonia, leading to ineffective antibiotic therapy. Upon readmission, laboratory findings revealed significant eosinophilia, initially reaching 1.15 K/µL (15.4%) and later increasing to 1.58 K/µL (18%), along with elevated total IgE levels and the presence of Toxocara canis antibodies, ultimately leading to the correct diagnosis of Löffler's syndrome. Antiparasitic treatment with albendazole yielded significant improvement in respiratory symptoms and a marked reduction in inflammatory markers, with eosinophil levels normalizing to 0.06 K/µL (0.6%). This case highlights the complexity of diagnosing atypical pneumonia in PCD patients, where rare parasitic infections may coexist with congenital abnormalities, complicating clinical management. Moreover, congenital disorders like Kartagener syndrome may increase susceptibility to parasitic infections, which are typically cleared from the respiratory tract but in such cases can more easily penetrate, accumulate, and multiply in lung tissue. Interdisciplinary collaboration integrating parasitology, immunology, and pulmonology was crucial for effective treatment. The case underscores the need for heightened awareness of parasitic infections in PCD patients and emphasizes the importance of comprehensive diagnostics, especially when standard therapies fail. Furthermore, it calls for future research into the interactions between congenital respiratory disorders like Kartagener syndrome and parasitic infections to better understand their impact on disease progression and treatment strategies.