Disseminated Lung Opacities and Cavitation Associated with Strongyloides Stercoralis and Schistosoma Mansoni Infection

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Abstract
A 20-year-old Ethiopian student arrived in Finland in October 1970. From then on he had epigastric discomfort and at times diarrheic stools. Six months later he was examined at the Out-patient Department for Tropical Diseases in Helsinki. The first two stool specimens contained no parasites or worm eggs. Erythrocyte sedimentation rate was 18 mm/hour and eosinophils 13.5% of a total leukocyte count of 5,300/mm3. On 2 April 1971 the patient was admitted with high fever. A chest film was normal. Eggs of Schistosoma mansoni and larvae of Strongyloides stercoralis were found in the stool. The eosinophil cells had disappeared from the blood. Treatment with niridazole and antibiotics was started, but the high fever persisted. A new chest film taken on the 13th day after admission showed extensive disseminated opacities all over the lungs, and cavitation of both lungs. Antituberculous treatment was started. A few days later the patient's general condition became alarming, pulmonary strongyloidiasis was suspected, and a course of thiabendazole was started, 1,500 mg twice daily for 2 days. The patient became afebrile and by the time the thiabendazole course was completed the chest film already showed a slight but distinct improvement, which continued slowly and steadily. The antituberculous treatment was discontinued 3 months later. Renal tuberculosis was detected half a year later.

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