Dear Editor,
“Esteem a horse, according to his pace, but lose no wagers on a wild goose chase.”
Our use of the mentioned phrase alludes to an undertaking, which will prove to be fruitless–and it is hard to imagine anything more doomed to failure than an attempt to catch a wild goose by chasing after it. Eosinophilia is a frequent laboratory finding in hospitalized patients and is often considered non-specific. However, in our patient it was an important piece of information that led to the diagnosis.
We recently had a 22-year-old African American female who presented to the Emergency department with complaints of shortness of breath, pleuritic chest pain, and a low-grade fever for the last 2 weeks. One week prior, she had experienced multiple episodes of loose, watery, bowel movements with mild abdominal discomfort. Due to acute presentation of shortness of breath she underwent serial ECGs, troponin-I, and a ventilation/perfusion (V/Q) scan and all of which were normal. Her chest X-ray showed a bibasalar lung opacities. She was admitted for further evaluation. Complete blood count showed the following: Hemoglobin, 10.7 g/dl; hematocrit 32%, white blood cell count, 9.2 with a differential showing 12.5% eosinophils and an absolute eosinophil count of 1150, platelets, 2,63,000/mcL. An electrolyte panel, renal functions, liver functions, and thyroid panel were normal. A hematology consult was obtained and patient underwent computed tomography scan of her chest and abdomen to rule out malignancy. However, this showed bilateral lower lobe consolidation without lymphadenopathy [Figure 1]. The possibility of a vasculitic process was raised and Anti-neutrophil cytoplasmic antibody ANCA panels, rheumatoid factor and HIV testing were performed and returned normal. A few days later strongyloides antibody was reported abnormal with extremely high titers consistent with current infection. Patient's mother was interviewed again and she reported that patient had wandered off on a beach infested with dog litter a month prior to her hospitalization.
Figure 1.
Computed tomography chest with contrast showed bilateral lower lobe consolidation without lymphadenopathy
The patient has Loeffler's syndrome caused by the parasite strongyloides stercoralis. It is predominantly a disease of developing nations and immigrants from endemic areas.[1] In the US, however, there is an increased prevalence of strongyloides infection in participants of New York State mental health program.
Information about this parasite should be included in US training and continuing medical education programs.[2]
References
- 1.Posey DL, Blackburn BG, Weinberg M, Flagg EW, Ortega L, Wilson M, et al. High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis. 2007;45:1310–5. doi: 10.1086/522529. [DOI] [PubMed] [Google Scholar]
- 2.Boulware DR, Stauffer WM, Hendel-Paterson BR, Rocha JL, Seet RC, Summer AP, et al. Maltreatment of Strongyloides infection: Case series and worldwide physicians-in-training survey. Am J Med. 2007;120:545.e1–8. doi: 10.1016/j.amjmed.2006.05.072. [DOI] [PMC free article] [PubMed] [Google Scholar]