C69-14 Incidental Pulmonary Nodules: A Case of Chronic Schistosomiasis

Abstract Case Report 87M, visiting from Ethiopia with a medical history of GERD and vertigo, presented with ataxia, resting tremors, and episodes of falls for 4 years. He also reported a chronic productive cough associated with 20kg weight loss, loss of appetite, and dysphagia. He worked at a gas station for over 45 years.While evaluating his symptoms, CXR showed a right upper lobe 4.5 x 3cm mass, lower lobe lesions suspicious of metastatic disease, and prominent bilateral interstitial markings. CT chest with contrast showed bilateral calcified perihilar masses associated with varying-sized multiple, varying-sized pulmonary nodules. On discussion with the patient and family, he had been diagnosed with schistosomiasis after multiple lung nodules were discovered incidentally in the UK. He was treated for schistosomiasis and reported that the lung nodules were chronic. Discussion Schistosomiasis can cause lung disease both in the acute and in the chronic phase. Acute schistosomiasis, also called Katayama syndrome, is a systemic hypersensitivity reaction against the migrating schistosomula and eggs, occurring a few weeks to months after the primary infection. Findings on chest radiograph include an interstitial pattern with micronodules and pleural and pericardial effusion. Pulmonary nodules with ground-glass attenuation areas are commonly found on CT scans. Katayama syndrome is usually diagnosed either by serology or, less frequently, by detecting schistosome eggs in urine or stool (depending on the species). In cases of acute pulmonary schistosomiasis, ectopic lesions disappeared after treatment with praziquantel in all cases, whereas the lesions commonly described in chronic pulmonary schistosomiasis are only partly reversible. Gaps in knowledge about the mechanisms that lead to the development of lung nodules or masses in chronic schistosomiasis still exist, and the proposed theories include the possibility that the migration of adult schistosomes throughout the body might not be uncommon, leading them to organs that are outside their traditional pathways. Although rarely reported in scientific literature, cases of lung nodules due to chronic schistosomiasis are probably more frequent than commonly thought. This abstract is funded by: None