Flu-like infection and liver disease after a trip to the tropics

History and admission findings: A 38-year-old patient, an experienced trave ller to the tropics, fell ill with a flu-like infection, a fever of up to 3 8.6 degrees C and nausea on returning from an 8-week trip to southern Afric a (Namibia, Zambia and Zimbabwe). Physical examination was unremarkable, ex cept for slight physical debility. His father had died of liver cirrhosis o f unknown aetiology, aged 68 years. Investigations: Laboratory tests revealed eosinophilia (12% on a count of 7 800 WBC/mu l, increased transaminase activities [SGPT 142 U/l, SGOT 50 U/I , gamma GT 32 U/I], slightly increased serum ferritin [1057 ng/dl], but nor mal serum iron and transferrin levels). Untreated stool contained Schistoso ma mansoni eggs. Tests for a haemochromatosis gene and its type showed a ho mozygotic 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 praziq uantel, 40 mg/kg by mouth on one day, divided in three doses, without compl ication. The haemochromatosis was treated symptomatically, at first by week ly bloodletting 500 ml while monitoring serum ferritin concentration. Life- long bloodletting at longish intervals is anticipated. Conclusions: The inc idence of some infectious diseases has greatly risen as a result of an incr ease 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 different ial diagnosis.