[Flu-like infection and liver disease after a stay in the tropics]

HISTORY AND ADMISSION FINDINGS: A 38-year-old patient, an experienced traveller to the tropics, fell ill with a flu-like infection, a fever of up to 38.6 degrees C and nausea on returning from an 8-week trip to southern Africa (Namibia, Zambia and Zimbabwe). Physical examination was unremarkable, except for slight physical debility. His father had died of liver cirrhosis of unknown aetiology, aged 68 years. INVESTIGATIONS: Laboratory tests revealed eosinophilia (12% on a count of 7,800 WBC/microliter, increased transaminase activities [SGPT 142 U/l, SGOT 50 U/l, gamma GT 32 U/l], slightly increased serum ferritin [1057 ng/dl], but normal serum iron and transferrin levels). Untreated stool contained Schistosoma mansoni eggs. Tests for a haemochromatosis gene and its type showed a homozygotic C282Y variant. Liver biopsy demonstrated chronic portal hepatitis with parenchymal transformation and marked haemosiderin deposits in liver epithelium. DIAGNOSIS, TREATMENT AND COURSE: The schistosomiasis was treated with praziquantel, 40 mg/kg by mouth on one day, divided in three doses, without complication. The haemochromatosis was treated symptomatically, at first by weekly bloodletting 500 ml while monitoring serum ferritin concentration. Life-long bloodletting at longish intervals is anticipated. CONCLUSIONS: The incidence of some infectious diseases has greatly risen as a result of an increase in tourism to distant lands. In particular, the diagnosis of frequent parasitic diseases should become part of the expertise in internal medicine. The combination of several diseases should be considered in the differential diagnosis.