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Abstract
A 26-year-old woman went to an emergency department in February, 2004, with acute left-sided chest pain. 10 days previously, she had taken a 13-hour flight, returning from a trip through Thailand, Guatemala, and Mexico. She also complained of pain in her abdomen and left calf. The doctors who saw her in the emergency department found nothing abnormal on examination. Chest radiographs showed a left-sided infiltrate (figure, left), and blood tests showed leucocytosis; 17×10^sup 9^/L, increased C-reactive protein and D-dimers. Given these results, in the context of a recent long haul flight, doctors suspected that she had a pulmonary embolism. They did a CT of the chest, but this showed no emboli. The patient was then referred to our outpatient clinic the next day with the presumptive diagnosis of tuberculosis. We looked at the full blood count and differential; she had eosinophilia; 6×10^sup 9^/L. She was no longer complaining of pain in her calf. Given her travel history, eosinophilia, and pulmonary infiltrate, we started looking for helminths. Six stool specimens and one sputum examination were negative for paragonimia, strongyloides, ascaria, filaria, toxocaria, and schistosomia. We did a pleurocentesis; the effusion was a turbid liquid consisting of eosinophils with no detectable parasites. We did an ultrasound of the liver which showed no flukes. However, serology was positive for fascioliasis. We therefore diagnosed acute fascioliasis and gave the patient a single dose of triclabendazole 10 mg/kg (Novartis Switzerland, under named patient programme).