A boy six year old with diagnosis of pleural effusion caused by Paragonimus ringer and hepatic abscesses caused by Fasciola gigantic. This patient presented with two months history of chest pain. On admission, lung examination revealed decreased breath sound on the right without difficulty in breathing. Pneumonia and a pleural effusion were diagnosed and chocolate - like fluid was drained. The eosinophil count in wac was higher than normal (51.7 percent)
The patient was treated with antibiotics Vancomycin and Ceforaxime, but his condition did not ameliorate. The patient was checked for a parasite in all samples of blood, pleural fluid, urine and stool. Finally, he was diagnosed positive with Paragonimus ringer (lgM positive). He was then treated with Praziquantel and his condition improved. However, after 6 days of treatment, this patient had abdominal pain and CT detected several small hypointense nodules in the hepatic parenchyma. The authors continued checking for Fasciola gigantic and Toxocara canis. Then, he was diagnosed positive with both Fasciola gigantic and Toxocara canis. The patient was treated with Triclabendazol two times. His condition was better, the authors recommend colleagues to check for parasitic disease when patients have an eosinophil count that is higher than normal and show no improvement with antibiotics.