A 45-year-old woman (Patient V.) has been registered as outpatient since 2015 with a diagnosis of bronchial hyperreactivity. For two years periodically she was bothered by paroxysmal cough with scanty sputum, fever up to 38-39  C, shortness of breath during exertion. Since November 2016 episodes of dyspnea were added, the body temperature rose to 37.8  C, and the administration of Beclomethasone and Amoxicillin had no effect. In January 2017 she was admitted to the Pulmonary Department of the hospital in Barnaul with a diagnosis of nonspecific interstitial pneumonia and unspecified eosinophilia. On admission, the woman had a complaint of shortness of breath in unstable cold weather, a rare unproductive cough, flying pains and swelling of the joints (elbow, knee, wrist) which were relieved by taking NSAIDs. Diagnosis at hospital: "Community-acquired bilateral polysegmental pneumonia in the upper lobes, moderate severity, respiratory failure 0 stage. Unspecified eosinophilia". After an antibiotic therapy (Ceftriaxone + Azithromycin) normalization of body temperature and a chest X-ray improvement have happened. After discharge from the hospital, flying pains reappeared in joints (elbow, knee, wrist). On an outpatient basis, in blood serum the antibodies against Opisthorchis, Toxocara canis, Giardia lamblia was examined by ELISA and Mycobacterium tuberculosis by PCR -with the negative results of all tests. Multi-slice computed tomography (MSCT) revealed the multiple areas of ground-glass interstitial infiltration with indistinct contours, irregular shape, thickening of the peribronchovascular and interlobular interstitium in the form of linear cords in both lungs, mainly in the upper lobes in the cortical and subpleural regions. The patient was admitted to the Pulmonary Department.
On admission to the pulmonary department, general condition was satisfactory. Body temperature was 36.7  C. The skin was a normal color without rashes. Peripheral lymph nodes were not palpable. Auscultation of the lung showed vesicular breath sound with breath rate 20/min., SatO2 - 97 %. Heart boundaries were displaced to the left by 1.5 cm lateral of the midclavicular line, the tones of heart were muffled, the rhythm was correct, heart rate was 90 per minute, blood pressure - 120/80 mm Hg. Edge of the liver was near the costal margin. There was no edema, urination was not frequent, stool was normal.
Results of the blood test presented in Table 1 and revealed some abnormalities: leukocytosis up to 12.9 x 109 / L (reference range: 4.0-9.0 x 109 / L), 56 %-24 % eosinophilia (reference range: (1-5 %) and ALT up to 229.2 U/L (reference range: 0-40 U/L), AST up to 110.7 U/L (reference range: 0-40 U/L), ALP up to 967 U/L (reference range: 0-130 U / L). Abdominal ultrasound showed diffuse homogeneous changes in the walls of the intrahepatic bile ducts, signs of bile thickening. X-ray examination revealed intrathoracic lymphadenopathy and bilateral areas of compaction of the lung tissue in the form of infiltrates. According to the lungs and mediastinum MSCT data, pronounced interstitial changes in the lungs which are characteristic of nonspecific interstitial pneumonia (sarcoidosis?) were revealed. No pathology was established by video bronchoscopy. Stool ova and parasite examination using concentration method (3-x negative results), studies of blood serum by ELISA (detection of IgM, IgG antibodies against Opisthorchis, Toxocara canis, Giardia lamblia) (Helminths-IgG-ELISA-BEST No. FSR 2009/04032, a set of reagents for enzyme detection of IgG to antigens of Opisthorchis, Toxocara canis, Trichinella, and Echinococcus in serum (plasma) of blood) (negative tests) were performed.
Multiple organ lesions: signs of allergic pneumonitis revealed by MSCT, arthralgic syndrome, hypereosinophilia (up to 56 % in the blood test), involvement of the hepatobiliary system, and anamnesis (accommodation from birth to the present time in an area where opisthorchiasis is endemic, the constant use of insufficiently heat treated fish) were the basis for a targeted search for parasitic invasion, primarily opisthorchiasis, as well as the exclusion of diffuse connective tissue diseases.
When carrying out the recommended set of examinations a month after discharge from the hospital, a large number of leukocytes, epithelial cells, and Opisthorchis felineus eggs were found in the duodenal contents. Complex therapy aimed at deworming (Praziquantel 75 mg / kg) followed by rehabilitation (taking cholagogue drugs - Ursodeoxycholic acid 10 mg / kg per day for up to 1 month), desensitizing (Levocetirizine 5 mg per day, up to 10 days) ensured a full clinical recovery and restoration of the quality of life (18 months follow-up period).