PMC5043414_01
The patient's initial chest radiograph at our facility at time of admission, demonstrating diffuse reticulonodular lung opacities (a). Marked improvement is seen by hospital day 4 (b), and complete radiographic resolution is demonstrated on a repeat outpatient film 21 days after admission (c).
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Physical exam was notable for supraclavicular retractions and sparse rales, and chest imaging demonstrated diffuse reticulonodular lung opacities (Fig. 1, Fig. 2). Pulmonary function testing on hospital day 4 revealed both restrictive and obstructive disease, with severe limitation of FEV1 (46% of reference improving to 52% of reference after albuterol, FEV1/FVC 79) and mild reduction of TLC (78% of reference) with evidence of air trapping (RV 146% of reference), despite improvement on chest radiograph (Fig. 1b). Seen in clinic 3 weeks later, he reported no further pulmonary symptoms and a chest radiograph demonstrated resolution of his interstitial disease (Fig. 1c).
A photo of the patient's fingernails, demonstrating soiling as well as damage from nail biting.
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A stool sample revealed no Ascaris eggs. As we had observed the patient to have significant, perseverative hand-to-mouth behaviors including onychophagia (Fig. 3), attempts were made twice to collect scrapings from his fingernail beds, but this failed to produce enough sample for analysis.
Microscopic analysis of the soil surrounding the pig enclosure demonstrated larvated Ascaris suum eggs (a). A non-larvated egg was isolated from fresh pig feces (b).
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Animal Disease Diagnostic Laboratory at LSU. Ascaris suum eggs (Fig. 4) were identified both in porcine fecal samples and in the soil immediately surrounding the pen.