Tehran University Medical Journal

Background: Hypereosinophilic syndrome is commonly found in various diseases such as allergic diseases, parasitic diseases, malignancies, etc. Fasciolosis may present with different clinical features, and it can make a difficult diagnosis of the disease. Laboratory manifestations of fascioliasis are eosinophilia. The purpose of this report was to introduce a child with hypereosinophilia that her diagnosis was fascioliasis.
Case Presentation: The patient was a 3-year-old girl who was referred for prolonged fever (more than two weeks) and abdominal pain from another medical center, and she was hospitalized. In abdominal and pelvic ultrasound, splenomegaly was seen and in laboratory tests, she had hypereosinophilia. In the flow cytometry of bone marrow aspiration, the only finding was increased eosinophil level. Abdominal and thoracic a computerized tomography (CT) scans showed an increased size of para-aortic lymph nodes. On her examination, lymphadenopathy was present in the inguinal region. Therefore, a biopsy of an inguinal lymph node was performed to rule out lymphoma. Lymph node biopsy was negative for lymphoma. Fasciola serology was performed for the patient, and the stool exam was collected three times (for one day in between) to rule out parasitic disease, including Fasciola, etc. Due to weakly positive serology Fasciola hepatica, triclabendazole was started for the patient (it was given in two doses, 12 hours apart), despite the absence of Fasciola parasitic eggs in her stool. During hospitalization, the patient’s fever was stopped and by starting the use of mentioned drug, eosinophilia was reduced. The patient received a complete improvement in the follow-up.
Conclusion: In patients with hypereosinophilia, parasitic diseases such as fascioliasis should be considered even if the fecal specimen is negative for Fasciola eggs.

Background: Congenital tuberculosis is a rare but serious disease in neonates and infants that often presents with nonspecific respiratory symptoms. Pulmonary involvement in tuberculosis can have similar manifestations to bacterial pneumonia with common microorganisms. In case of failure to respond to treatment in pneumonia,  tuberculosis infection should be considered. The aim of this study was to present a two-month-old infant suspected of bacterial pneumonia, who was ultimately diagnosed with tuberculosis.
Case Presentation: This case report describes a two-month-old infant diagnosed with tuberculosis who presented to the emergency department with severe respiratory distress.  Despite repeated hospitalizations and initial antibiotic therapy, the patient's symptoms did not improve and he was eventually referred to the Children's Medical Center. Chest radiography showed diffuse reticular opacities, alveolar opacities in the lower lobe of the right lung, and parahilar opacities in the left lung. Initial laboratory tests included elevated CRP and ESR levels, elevated white blood cell count, thrombocytosis, and abnormal arterial blood gases. Despite three negative gastric aspirate samples for tuberculosis, bronchoscopy was performed and a Bronchoalveolar Lavage (BAL) sample was sent for Polymerase Chain Reaction (PCR) testing for Mycobacterium tuberculosis, which was positive, confirming the diagnosis of tuberculosis. Careful evaluation of the parents revealed that although they had no respiratory symptoms, the mother had imaging evidence of tuberculosis, and her AFB test was positive. The patient showed significant clinical improvement after starting anti-tuberculosis therapy. A six-month follow-up confirmed complete recovery.
Conclusion: In infants with recurrent pneumonia and failure to respond to initial treatments, tuberculosis should be considered as a possible diagnosis.

Background: Cystic echinococcosis is an endemic parasitic disease in Iran that predominantly affects the lungs in children. Progressive chest wall deformity as the presenting manifestation of the disease has rarely been reported, particularly in cases with concurrent pulmonary and hepatic involvement. Because this presentation is uncommon, recognition of its clinical features may contribute to earlier diagnosis and appropriate management. Case Presentation: In November 2025, a 10-year-old girl from a rural area was referred to Children’s Medical Center, Tehran, Iran, with poor appetite, weight loss, and progressive protrusion of the right side of the chest wall. Physical examination revealed obvious thoracic asymmetry and decreased breath sounds over the right hemithorax. Chest computed tomography demonstrated a large cystic lesion measuring 184×133 mm in the right lung, associated with mediastinal shift and collapse of the adjacent lung parenchyma. A second cystic lesion was also detected in the left hepatic lobe. Hydatid serology was positive. Based on the clinical, radiological, and serological findings, hydatid disease involving both the lung and liver was suspected. The patient subsequently underwent surgical treatment of the pulmonary hydatid cyst followed by hepatic cyst surgery. Histopathological examination confirmed the diagnosis. The coexistence of pulmonary and hepatic cysts, together with progressive chest wall deformity, made this presentation unusual. Conclusion: This case demonstrates that progressive chest wall deformity may represent the first clinical clue to a giant pulmonary hydatid cyst in children. Awareness of this uncommon presentation may facilitate earlier recognition of the disease in endemic regions. Early diagnosis may reduce delays in treatment and help prevent disease-related morbidity. This report also highlights the importance of considering hydatid disease in children presenting with gradual thoracic asymmetry, even in the absence of severe respiratory symptoms.