Patient 1.—A previously healthy 2-year-old girl presented with an intermittent low-grade fever, watery diarrhea, malaise, and decreased appetite of 6 weeks' duration. She lived in a rural community on a farm and had a pet dog. The parents confirmed a history of pica. Results of examination revealed a well-developed child with no abnormal physical findings. The lungs were clear on auscultation, the liver was not enlarged, and the optic fundi were normal.
Her white blood cell count was 42.4 × 109/L, with.05 band forms,.13 segmented neutrophils,.29 lymphocytes,.12 monocytes, and .41 eosinophils (the absolute eosinophil count was 17.4 × 109/L). The Westergren erythrocyte sedimentation rate was 87 mm/h, and results of stool examination for ova and parasites were negative. The serum IgG level was greater than 20 g/L, and isoagglutinin titers to A and B blood group antigens were normal. Figure 1 shows the patient's frontal chest radiograph.