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

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