Chest helical computed tomography scan shows pulmonary micronodules and condensation in acute schistosomiasis mansoni

Abstract

A 15-year-old boy developed persistent fever and a diffuse maculopapular rash 21 days before admission to hospital. He was treated with antibiotics and symptomatic drugs without improvement. Clinical examination revealed a well developed underweight teenager, with pale skin. His axillary temperature was 39.3ºC. There was no history of diarrhea. Abdominal palpation showed painful hepatomegaly and splenomegaly. Leukocytosis (38,000 cels/mL) and eosinophilia (30,400 cels/mL) were found in a routine blood count. Platelet counts and hemoglobin levels were within the normal range and serum alanine aminotransferase was slightly elevated. Abdominal ultrasound showed liver and spleen enlargement and periportal lymph nodes. Schistosoma mansoni eggs were described in the stools. He reported contact with stream water in an endemic area for schistosomiasis 30 days before the start of symptoms. A chest helical computed tomography (CT) scan with multiplanar reconstruction and maximum intension projection (MIP) technique demonstrated bilateral scattered nodules and consolidation in left upper lobe (Figure A). A sagittal reconstruction of left lung showed two consolidations in upper and lower lobes (Figure B; arrows). O paciente, de 15 anos, desenvolveu febre e erupção cutânea maculopapular difusa 21 dias antes da admissão hospitalar. Ele fez uso de antibióticos e sintomáticos sem melhora do quadro. Ao exame clínico, o adolescente aparentava bom desenvolvimento somático e encontrava-se emagrecido. A pele era pálida e a temperatura axilar elevada (39,3ºC). Não havia relato de diarréia. O fígado e o baço eram palpáveis e dolorosos. O hemograma revelou leucocitose (38.000 células/mL) e eosinofilia (30.400 células/mL); a contagem de plaquetas e o nível de hemoglobina eram normais. A alanina-aminotransferase estava ligeiramente aumentada no soro. A ultrassonografia abdominal confirmou aumento do fígado e do baço e identificou linfonodos periportais. No exame parasitológico das fezes, havia ovos viáveis de Schistosoma mansoni. O paciente relatou contato com águas naturais em área endêmica para esquistossomose 30 dias antes do adoecimento. Tomografia computadorizada (TC) helicoidal com reconstruções multiplanares e técnica MIP (maximum intension projection) demonstraram nódulos esparsos bilaterais e consolidação no lobo superior esquerdo (Figura A). Na reconstrução no plano sagital, observou-se no pulmão esquerdo duas consolidações pulmonares nos lobos superior e inferior (Figura B; setas).

Characterisation of inflammatory response, coagulation, and radiological findings in Katayama fever: a report of three cases at the Medical University of Vienna, Austria

“…Distinct radiographic abnormalities of the lungs in Katayama fever, including patchy pulmonary infiltrates on chest X-ray and single/multiple pulmonary nodules with ground-glass halos on CT, have been previously described [8-10]. However, radiological alterations in other viscera have been less well described.…”