A 38-year-old woman with a Sierra Leonean background presented to our institution complaining of pleural pain, fever, and cough. She had a history of human immunodeficiency virus successfully treated with triple therapy and a recent subclinical COVID-19 infection. The patient had not been to Sierra-Leone for 10 years and there was no history of recent travelling or contact with sick patients or Tuberculosis patients.
Physical examination was unremarkable. Laboratory tests showed leukocytosis with eosinophilia (0.8 10.E9/l) and high CRP (33.7). Further investigation done with a urinary sample, broncho-alveolar lavage, and serological tests (syphilis, hepatitis, Q-fever) concluded negative.
High resolution CT (HRCT) a few days after admission demonstrated multiple nodular zones of consolidation with surrounding ground glass in the left lower lobe (Figure 1A). No TBC-associated lesions or calcified nodes were observed. The first follow-up HRCT was scanned after seven days (Figure 1B) of watchful waiting without any medical therapy. These follow-up images demonstrated a spontaneous regression of some lesions where other nodular lesions demonstrated expansion compared to one week prior. Subsequently the previously described finding of migrating nodular lesions were confirmed on one-month follow-up computed tomography (CT) scan.
The serology was eventually positive for schistosomiasis (IgE 556) and treatment was started (Praziquantel) with an interval of two weeks in between doses. On this therapy the patient improved with significant clinical response and a regression of CRP and eosinophilia.