Man with Raynaud’s disease who emigrated from Cambodia

endotracheal aspirate of a patient with pulmonary infiltrates

Question

A 46-year-old man with Raynaud’s disease who emigrated from Cambodia 30 years ago presented with a 2-month history of myalgias, exertional dyspnea, and an elevated level of creatine kinase. An extensive evaluation was notable for the ground-glass infiltrates detected in the lower lobes on a computed tomographic scan of the thorax. Serologic tests and bronchoalveolar lavage were unrevealing. A specimen from a muscle biopsy showed necrotizing myopathy. Empirical therapy with oral corticosteroids was begun for treatment of an inflammatory condition that was presumed to be noninfectious. Four weeks after therapy was initiated, the muscle weakness and dyspnea were worse and there was progression of the pulmonary infiltrates. While the patient was waiting to undergo an open-lung biopsy, pulmonary hemorrhage, hypoxemic respiratory failure, and fulminant septic shock with Escherichia coli occurred.

This worm was identified in an endotracheal aspirate of a patient with pulmonary infiltrates. What is the infecting organism?

Ascaris lumbricoides
Clonorchis sinensis
Paragonimus westermani
Strongyloides stercoralis
Toxoplasma gondii

 

 

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A 50-year-old man presented for a routine physical examination for the first time in 10 years.

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A 60-year-old woman with a family history of colon cancer and a history of adenomatous colorectal polyps underwent surveillance colonoscopy.

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A Girl had a 2-year history of abdominal pain

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What is the diagnosis?

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