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Katayama syndrome — DTM&H MCQ

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HardTravel MedicineKatayama syndromeDTM&H

A 60-year-old man returns from a 2-week safari in Tanzania and presents with a 4-day fever and dry cough 10 days after return. He received appropriate malaria prophylaxis and has a negative blood film. Chest radiograph shows bilateral infiltrates. Blood cultures are negative. What should be included in the differential diagnosis?

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Correct answer: B — Acute schistosomiasis (Katayama syndrome)

Acute schistosomiasis (Katayama syndrome) presents 2-8 weeks after freshwater exposure in endemic areas with fever, cough, urticaria, eosinophilia, and pulmonary infiltrates. It is a serum-sickness-like immune complex reaction to maturing schistosomula. Safari travellers often swim in lakes (e.g. Lake Malawi, Lake Victoria). Eosinophilia is a key diagnostic clue. Stool/urine microscopy may be negative this early; serology is more sensitive. Treatment: praziquantel (may need to repeat after maturation) plus corticosteroids for severe reactions.

Reference: Manson's Tropical Diseases; CDC Yellow Book