On examination he was pvrexial (oral temperature, 38°C), pulse rate was 100 beats per minute, and blood pressure was 100/80 mm Ilg. There were no clinical signs of cardiac failure. His chest was normal but he was unable to take* a deep breath due to pleuritic pain. Abdominal examination revealed hepatospleiiomegaly and generalized tenderness. Bowel sounds were present and findings from rectal examination were normal.
Initial investigations showed a total white blood cell count of 19,200/cii mm with 39 percent eosinophils; hemoglobin level was 11.fig/dl w ith a microcytic, hypochromic blood picture. Hemoglobin electrophoresis showed no abnormality and bone marrow examination showed only an increased numlier of eosinophil precursors. A chest roentgenogram at the time of hospital admission showed blunting of the right costophrenic angle consistent with a small pleural effusion (Fig 1). Arterial blood gas determinations were as follows: pH, 7.42; PaCO,, 34 mm Hg; Pa02, 59 mm Hg; and HCO„ 22.3 inKq/1. while breathing room air. Abdominal roentgenograms were normal. Ultrasonography of the abdomen confirmed hepatosplenomegaly with periportal fibrosis compatible with chronic schistosomiasis, but there was no evidence of intrahepatic or subdiaphragmatic abscess formation. buy flovent inhaler
Figure 1. Chest roentgenogram at time of hospital admission showing blunt right costophrenic angle due to a small pleural effusion.