A 28-year-old woman complains of nausea, stomachache, pain in her tongue, and liquid feces. Three days ago she ate poorly salted pike caviar. Objectively her skin is pale, the tongue looks "lacquered" (bald tongue). Pulse is 100/min., with muffled heart sounds and systolic murmur over the cardiac apex. Blood pressure is 95/50 mm Hg. The liver is enlarged by 3 cm. Hemogram shows anemia, eosinophils – 18%. Oval helminth eggs were detected in feces. Make the provisional diagnosis:

Answer options

1. Ascaridiasis
2. Diphyllobothriasis
3. Taeniarhynchosis
4. Trichinosis
5. Teniasis

Explanation

Diphyllobothriasis is a long-lasting infection. Most cases are asymptomatic. Manifestations may include abdominal discomfort, diarrhea, vomiting, and weight loss. Vitamin B12 deficiency with pernicious anemia may occur (“lacquered” bald tongue). Massive infections may result in intestinal obstruction. Migration of proglottids can cause cholecystitis or cholangitis Harrison’s Principles of Internal Medicine / Dennis L. Kasper et al. – 19th edition. – New York: McGraw Hill Education, 2015. – P. 1434