Coughing Up a Diagnosis: A Cavitary Lung Lesion with Worsening Eosinophilia

Sekiguchi et al detail their assessment, diagnosis, and treatment of a 37-year-old woman from Botswana who appeared to have community-acquired pneumonia when, in fact, she had a more exotic infection. She was hospitalized with a productive cough and dyspnea of two days' duration. Right lower lobe consolidation was seen on a chest x-ray. Her past medical history was unremarkable. The differential diagnosis of a cavitating lung lesion in the context of peripheral eosinophilia includes bacterial, fungal, and parasitic infections; vasculitis or autoimmune diseases; eosinophilic pneumonias; and drug reactions. Serum autoantibodies and a vasculitis panel were negative, and a stool examination came back negative for parasitic ova, larvae, and protozoa. However, a wet preparation of sputum contained echinococcal hooklets. Subsequent tests for serum IgE and IgG echinococcal antibodies were positive, further supporting a diagnosis of pulmonary cystic echinocoecosis.