Chronic Hemoptysis in a Traveler from Colombia
Clinical Vignette
A 34-year-old man presents with 4 months of chronic cough, intermittent pleuritic chest pain, and recurrent hemoptysis. He reports progressive fatigue and 4 kg of weight loss, but remains functionally active.
Six months before symptom onset, he spent several weeks in a rural riverine area of Colombia where he frequently ate local marinated freshwater crabs. He reports household exposure to pulmonary tuberculosis during adolescence and a recent coworker treated for active TB. He has no prior chronic lung disease.
Examination shows mild tachycardia and scattered crackles. Chest imaging revealed a left patchy upper-lobe infiltrates with a small cavitary lesion. Labs show WBC 9,800 cells/uL with eosinophils 8% (absolute eosinophil count 780 cells/uL). Initial AFB sputum smear is negative, MTB PCR is negative, and routine bacterial sputum cultures are negative.
CT chest without contrast.
Question
What is the most likely diagnosis?
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Question 2
Which treatment is most appropriate for uncomplicated pulmonary paragonimiasis?
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References
Velez ID, Ortega JE, Velasquez LE. Paragonimiasis: a view from Colombia. Clinics in Chest Medicine.