Pulmonary nodules and pleural effusion in the acute phase of schistosomiasis mansoni

Abstract

A 39-year-old Brazilian woman presented with a 20-day history of fever, diarrhoea, myalgia, dyspnoea and cough. She reported contact with natural waters in an area endemic for schistosomiasis in the past 60 days. Her liver and spleen were soft and tender on palpation. Blood tests revealed leukocytosis with 1960 eosinophils per mm 3; stool examination showed Schistosoma mansoni eggs. Hepatosplenomegaly and several periportal lymph nodes were observed on abdominal ultrasound. Chest radiography showed nodules at the base of the right lung and pleural effusion in the left lung, which were confirmed with computed tomography (images included in the article). The nodules seemed to coalesce in some areas, simulating pulmonary condensation. The patient was given a single dose of praziquantel (50mg/kg of body weight) for the schistosomiasis. One day later, the patient developed malaise, high fever, chest pain, dry cough and dyspnoea with diffuse wheezing. She was diagnosed to have pulmonary embolism due to the dead worms, and was treated with prednisone (1mg/kg of body weight, in a single dose daily) for seven days, with rapid improvement of her condition. Prednisone dose was tapered and subsequently discontinued.