Migrating

Immune System


Step 1: View Clinicals

A 27 year old man presents with a non-productive, paroxysmal, nocturnal cough for five days associated with breathlessness and wheezing.


There is no history of chronic respiratory illness, atopy or tuberculosis. His medical, surgical, and drug histories are unremarkable.


He does not smoke or consume alcohol. He migrated from India to the United States just 4 months ago.


Initial investigations reveal a white cell count of 28,000/mm3, with an eosinophilia of 21,300/mm3. A chest x-ray reveals scattered reticulonodular infiltrates in the mid and lower zones of both lungs.


Step 2: Order Relevant Investigations

1. Stool Microscopy

check

No ova or parasites seen.

2. Serum IgE levels

check

IgE: 24,020 kU/L (0-120)

3. Filaria specific IgG levels

check

Filaria specific IgG: Positive

4. Serology for Toxocariasis

check

Serology for toxocariasis: Negative

Step 3: Select Appropriate Management

1. Supplemental Oxygen

clear

2. Diethylcarbamazine

check

3. Prednisolone

check

4. Ivermectin

clear