Hemoptysis associated with paragonimus westermani
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A 49-year-old man who had recently emigrated from Myanmar presented with a 6-month history of rusty brown sputum with hemoptysis. A tuberculin skin test was positive, but sputum smears were negative for acid-fast bacilli, ova, and parasites. A chest radiograph and an axial computed tomographic image showed a cavitary lesion in the anterior segment of the left upper lobe, measuring 14 mm in its largest diameter (Panel A), ground-glass opacities in the right lung, a pretracheal lymph node measuring 11 mm in its largest diameter, and a partially loculated left pleural effusion.The patient was treated empirically for tuberculosis, but there was a clinical and radiologic progression of a disease. Bronchoalveolar lavage was performed, and Papanicolaou staining of a specimen of the fluid revealed brown, oval eggs with an operculum (a cap) that were suggestive of Paragonimus westermani (Panel B)...

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