I’ve Got the Black Lung Fluke


    I’ve Got the Black Lung Fluke

    Post by @JoePinero

    25 yo M no phx, from Ecuador, in US for 6 months, CC 1 month of cough w/speckled hemoptysis, +intermittent subjective fevers responsive to tylenol/motrin. +Wt loss of 7-10 lb’s in past month. In Ecuador worked as fisherman in a small village.

    Vitals: 99.9 (oral) 113  130/80  98%RA
    Gen: Well-appearing, thin male, coughing frequently
    Resp: mild crackles LLL, no resp distress
    Abd: Soft, non-tender, non-distended
    Ext: No periph edema
    Skin: No rash

    CBC: 10 > 14/40 < 220   seg 80%  eos 8.3

    Chest XR Cxr






    Ct Fluke


    Chest CT shows lung cyst with lung fluke within

    Lung pathology shows Paragonimiasis

    Some facts about Parasitic Helminth infections
    – most common in far east or South America
    – Mod of infection is through ingestion of snail, crayfish, crab and other small crustaceans
    – common sx are recurrent hemoptysis, fever, streaky small infiltrate on chest xr, eosinophilia
    – can see pleural effusion in up to 60% cases
    – treat with PRAZIQUANTEL or triclabendazole

    Praziquantel has an unknown mechanism of action but has been effective in treating flatworm infections

    Think of a parasitic helminth infection in patient with eosinophilia and hemoptysis, especially if they are from South America and/or East Asia.