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Mystery Diagnosis

It was the flu that wouldn’t go away. From September 2009 to February 2010, Adam Brewer had everything from shortness of breath and reduced energy to fluid on his lungs and heart. The worst part was that doctors had no idea what was wrong. Ready to give up, Brewer went to the physicians at Washington University and Barnes-Jewish Hospital. A week later, he was on the road to recovery and had an unusual story to tell.


Mystery patient, Florissant, Mo.

It should have been an episode of House. It was that strange. In September 2009 when I started feeling ill, my regular doctor just thought it was the flu. They did chest X-rays, blood work, CT scans; when tests came back with no answers, they did more tests. The doctors asked me everything and couldn’t understand why I kept coming back.

By the time I went to Barnes-Jewish in February 2010, I was seeing a doctor nearly two days a week. Even on the first visit, the doctor was confident and comforting. He asked similar questions and redid tests, but then something must have clicked. They decided to do a new test for a parasite in crawfish. My mom didn’t think it was a possibility until I remembered a float trip the previous summer. Uncles and older cousins had been eating raw crawfish for years, so I had tried a little bitty one to make the kids laugh.

For it to last that long and be cured by just 30 pills in a week is mind-blowing. I had given up. I didn’t think it would work until I felt the change. And I will never again eat raw crawfish. I’ve learned my lesson the hard way. Brewer’s story is being featured on Discovery Health’s Mystery Diagnosis. See local listings for more information.

Thomas Bailey, MD

Washington University infectious disease specialist

Paragonimus, a parasitic worm in raw crawfish, is the size of the tip of a pen when ingested. They usually travel from the intestine to the lungs and sometimes to the brain, where they can cause severe headaches and vision problems. Symptoms include fever, difficult breathing, chronic cough, extreme fatigue and chest and abdominal pain. The illness is curable but rare enough that physicians often overlook it. Symptoms, if left untreated, can persist for years, even decades.

A medication used to kill tapeworms did the trick. The story of this unusual case highlights the importance of getting a thorough medical history in order to arrive at an accurate diagnosis. You have to be a bit of a detective and remain open to all the clues. In this patient’s case, the duration of his symptoms already defined him as having something unusual, if not rare.

Adam’s case is just one of 13 ever recorded in the US. Sometimes people are just showing off, but it is a nutty thing to do. And crawfish pinch.If you’re going to eat them, cook them first. They are better that way anyway. 
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