On the second day after hospital admission his general condition deteriorated and he became tachypneic (respirations, 40/min) at rest. A repeated chest rot*ntgenogram showed large right-sided and small left-sided pleural effusions (Fig 2). An echocardiogram revealed a moderate-sized pericardial effusion but there was no clinical or echocardiographic evidence of cardiac tamponade. By this time, he had also developed clinically detectable ascites. As the patient was very symptomatic 1 L of fluid was aspirated from his right pleural cavity. The peritoneal and pleural fluid were both exudates containing six to eight eosinophils per high-power field of 40 to 50 cells. Fluid examination and cultures for all microorganisms, including mycobacteria, were negative. Blood cultures were sterile on several occasions; stool microscopy and cultures showed no pathogens.
Mantoux test with 10 U of purified protein derivative was negative and a pleural biopsy specimen showed no granuloma. Antinuclear factor and anti-DNA autoantibodies were not detected. buy asthma inhalers
He was treated with bed rest, acetaminophen (paracetamol), and oxygen inhalation. After three days of this supportive therapy his condition started to improve. All his symptoms, including abdominal pain and fever, cleared. The pleural effusions, ascites, and pericardial effusion resolved as confirmed by follow-up chest roentgenogram and echocardiogram. Mis arterial blood gas determinations also returned to normal (pH, 7.49; PaO,, 100 mm Hg; PaCC)2, 35 mm Hg; and saturation, 99 percent); his white blood cell count at the time of hospital discharge was 7200/cu mm (eosinophils, 15 percent). A rectal biopsy specimen confirmed the presence of dead Schistosoma ova.
Figure 2. Chest roentgenogram 24 h after hospital admission showing an increase in pleural effusion on the right side and appearance of small effusion on the left. Cardiac silhouette is enlarged suggesting pericardial effusion.