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Reversed halo sign in acute schistosomiasis.

Souza Jr AS, Souza AS, Soares-Souza L, Zanetti G, Marchiori E - J Bras Pneumol (2015 May-Jun)

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil.

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Another HRCT scan, obtained four months after treatment, showed no abnormalities... Schistosomiasis is a major helminthic infection in tropical and subtropical regions; it has affected an estimated 200 million people, resulting in considerable morbidity and occasional mortality... Humans are colonized by three major species of the parasite: S. mansoni, common in Africa, the Middle East, and South America; S. haematobium, common in Africa and the Middle East; and S. japonicum, common in Japan and China... Schistosomiasis progresses through three phases, as defined by the migration of the helminth: allergic (cercarial) dermatitis, which occurs during the penetration of cercariae into the skin; acute schistosomiasis, which occurs during the oviposition phase; and chronic schistosomiasis, caused by the formation of granulomas and fibrosis around the helminth eggs retained in the pulmonary vasculature, which can result in arteriolitis obliterans, pulmonary hypertension, and cor pulmonale... Symptoms and signs can include fever, chills, weakness, weight loss, headache, nausea, vomiting, diarrhea, hepatomegaly, and splenomegaly... The disease is usually self-limited, but severe cases can result in death... The most common CT finding in patients with acute pulmonary schistosomiasis is that of small (2- to 15-mm) pulmonary nodules... Although organizing pneumonia is considered to be the most frequent cause of the reversed halo sign, morphological aspects of the halo, particularly the presence of small nodules in the wall or inside the reversed halo, strongly suggest a diagnosis of active granulomatous disease, especially pulmonary tuberculosis or pulmonary sarcoidosis... In the present case, the reversed halo sign was observed in a patient with acute schistosomiasis... In conclusion, schistosomiasis should be considered in the differential diagnosis of nodular reversed halo sign, particularly in patients with an epidemiological history suggestive of the disease... In the case presented here, the analysis of histological sections demonstrated that the nodules were related to the presence of granulomas.

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Histological sections: in A, areas of granulomatous inflammation and inflammatory infiltration of the alveolar septa (H&E staining; magnification, ×40); in B, schistosome ova (arrows) inside a granuloma. (H&E staining; magnification, ×100).
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f02: Histological sections: in A, areas of granulomatous inflammation and inflammatory infiltration of the alveolar septa (H&E staining; magnification, ×40); in B, schistosome ova (arrows) inside a granuloma. (H&E staining; magnification, ×100).

Mentions: Blood tests showed leukocytosis with eosinophilia. Bronchoalveolar lavage findings were negative. The patient underwent open lung biopsy. Histological examination of the biopsy sample demonstrated areas of parenchymal granulomatous inflammation, with clusters of epithelioid histiocytes, giant cells, and some eosinophils. In addition, those areas were surrounded by chronic inflammatory cell infiltrate and numerous schistosome ova (Figure 2). The final diagnosis was acute schistosomiasis.


Reversed halo sign in acute schistosomiasis.

Souza Jr AS, Souza AS, Soares-Souza L, Zanetti G, Marchiori E - J Bras Pneumol (2015 May-Jun)

Histological sections: in A, areas of granulomatous inflammation and inflammatory infiltration of the alveolar septa (H&E staining; magnification, ×40); in B, schistosome ova (arrows) inside a granuloma. (H&E staining; magnification, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541767&req=5

f02: Histological sections: in A, areas of granulomatous inflammation and inflammatory infiltration of the alveolar septa (H&E staining; magnification, ×40); in B, schistosome ova (arrows) inside a granuloma. (H&E staining; magnification, ×100).
Mentions: Blood tests showed leukocytosis with eosinophilia. Bronchoalveolar lavage findings were negative. The patient underwent open lung biopsy. Histological examination of the biopsy sample demonstrated areas of parenchymal granulomatous inflammation, with clusters of epithelioid histiocytes, giant cells, and some eosinophils. In addition, those areas were surrounded by chronic inflammatory cell infiltrate and numerous schistosome ova (Figure 2). The final diagnosis was acute schistosomiasis.

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Another HRCT scan, obtained four months after treatment, showed no abnormalities... Schistosomiasis is a major helminthic infection in tropical and subtropical regions; it has affected an estimated 200 million people, resulting in considerable morbidity and occasional mortality... Humans are colonized by three major species of the parasite: S. mansoni, common in Africa, the Middle East, and South America; S. haematobium, common in Africa and the Middle East; and S. japonicum, common in Japan and China... Schistosomiasis progresses through three phases, as defined by the migration of the helminth: allergic (cercarial) dermatitis, which occurs during the penetration of cercariae into the skin; acute schistosomiasis, which occurs during the oviposition phase; and chronic schistosomiasis, caused by the formation of granulomas and fibrosis around the helminth eggs retained in the pulmonary vasculature, which can result in arteriolitis obliterans, pulmonary hypertension, and cor pulmonale... Symptoms and signs can include fever, chills, weakness, weight loss, headache, nausea, vomiting, diarrhea, hepatomegaly, and splenomegaly... The disease is usually self-limited, but severe cases can result in death... The most common CT finding in patients with acute pulmonary schistosomiasis is that of small (2- to 15-mm) pulmonary nodules... Although organizing pneumonia is considered to be the most frequent cause of the reversed halo sign, morphological aspects of the halo, particularly the presence of small nodules in the wall or inside the reversed halo, strongly suggest a diagnosis of active granulomatous disease, especially pulmonary tuberculosis or pulmonary sarcoidosis... In the present case, the reversed halo sign was observed in a patient with acute schistosomiasis... In conclusion, schistosomiasis should be considered in the differential diagnosis of nodular reversed halo sign, particularly in patients with an epidemiological history suggestive of the disease... In the case presented here, the analysis of histological sections demonstrated that the nodules were related to the presence of granulomas.

Show MeSH
Related in: MedlinePlus