A 14-year-old male student presented to our hospital with 5-week history of fever, rigors, cough and malaise for 1 month after returning from a visit to Albaha province (south of Saudi Arabia). He had been evaluated initially in a local hospital and diagnosed with community-acquired pneumonia. He received IV antibiotics and was discharged home on oral antibiotics.\nDuring hospitalization, he had an extensive work-up for fever of unknown etiology that included multiple blood cultures, urine analysis and culture, sputum for acid-fast bacilli (AFB), routine sputum cultures, serology for brucellosis, Monospot test and blood film for malaria. His clinical examination was unremarkable; complete blood count (CBC) and differential count, renal functions and serum electrolytes, chest X-ray and transthoracic echocardiogram were all unremarkable. His liver profile was mildly deranged with aspartate aminotransferase (AST) activity of 48 U/L and alanine aminotransferase (ALT) activity of 82 U/L. He was discharged home and given outpatient appointment for follow-up.\nHe was re-admitted again 16 days later because of persistence of his symptoms. His clinical examination was also unremarkable. His laboratory investigations, however, were as follows: WBC count 8.1×109/L (eosinophils 30%; lymphocytes 35%; monocytes 7%; neutrophils 25%; and bands 3%), Hb=121 g/L, and platelets 438×109/L)\nHis chest X-ray showed ill-defined infiltrate. Thus, a chest computed tomography (CT) was requested and revealed peripheral nodular and patchy infiltrates in both lung fields []. There was evidence of splenomegaly in the lower cuts of the scan.\nRepeated CBC and differential count was significant for increasing peripheral blood eosinophil count to 63%, with an absolute count of 9.4×109/L and WBC of 14.9×109/L. Blood, urine, sputum cultures and sputum for AFB were negative. Two stool samples for microscopy were negative for parasite. Serum IgE level was 334 U/L, (normal <200 U/L), ANCA-P test was negative, and renal functions and liver function tests were unremarkable.\nBronchoscopy was performed. Bronchoscopic alveolar lavage (BAL) fluid analysis showed marginally elevated eosinophils (7%); however, microbial studies (including AFB, fungal and routine bacterial cultures) were negative. A transbronchial biopsy showed tissue eosinophilia.\nThe patient underwent video-assisted thoracoscopic lung biopsies from the left lower lobe which showed a schistosomal ovum within a well-formed granuloma []. Subsequently, the test for schistosoma antibodies serology came positive. The diagnosis of acute pulmonary schistosomiasis was then made.\nThe patient was given praziquantel (20 mg/kg body weight) twice daily for 2 days. Two days later, he reported to our emergency department with high-grade fever and rigors. His symptoms subsided with the addition of a short course of prednisolone. After this, he visited our outpatient clinic for follow-up and was free of symptoms and had a normal chest X-ray.
A 24-year-old Yemeni male without any previous medical history presented to the emergency department complaining of sudden right-sided chest pain with shortness of breath after taking a shower earlier the same day. Upon questioning, there was no history of trauma, cough, recent travel to potentially endemic areas, recent infection, or any previous similar symptoms. Regarding his vital signs, he was afebrile with a heart rate of 78, respiratory rate of 20, blood pressure of 124/65 mmHg, and oxygen saturation of 96%. He was well-oriented and alert but showed signs of respiratory distress and difficulty in respiration. His chest examination revealed decreased air entry on the right side and normal breathing on the left side. Meanwhile, his other systemic examinations were unremarkable. His investigational panel included complete blood count (CBC) with differential was within normal limits except for isolated eosinophilia. Furthermore, electrolytes and cardiac markers were normal while tuberculosis acid bacilli were negative and blood culture showed no growth. Later, a chest X-ray (CXR) showed right-sided pneumothorax and a collapsed lung (Figure ) with no mediastinal shift. Therefore, the patient was admitted, and a chest tube was inserted accordingly.\nThe following day, a persistent air leak was noted in the chest tube without resolution of the pneumothorax, which raised the suspicion of the presence of a fistula. The following day, the patient underwent bullectomy, pleurectomy, and pleural abrasion via a video-assisted thoracoscopic surgery (VATS). The patient continuous leak was resolved, and there were no signs of an active leak in the following 24 hours. The resected wedge weighed 3 g and measured 3.5 x 2.0 x 1.0 cm. Histopathology cross-section of the specimen was stained with hematoxylin and eosin (H&E) stain showing signs of schistosomiasis eggs of Schistosoma mansoni (Figure ) and was discharged on praziquantel with a follow-up appointment. The patient then failed to follow up further.