38-year-old male presented to the primary care clinic with intermittent epigastric pain for 14 months. Symptoms are associated with anorexia, early satiety, and nausea. He denies fever, chills, weight change, or bowel habit change. He was diagnosed with HIV infection 10 years prior and remains well controlled on EFV/FTC/TDF with undetectable viral load and CD4 count 560 cells/mm2. He immigrated to the midwestern US from Cambodia two years ago. He works as a librarian, enjoys hiking and gardening with his husband of 18 months. He denies pets, farm animal contact, recent travel, or sick contacts.
Physical exam revealed tenderness around the epigastrium and right upper quadrant area with mild hepatomegaly. Labs revealed peripheral eosinophilia and mildly elevated AST, ALT, and total bilirubin. Abdominal CT, and stool for ova and parasites were obtained, shown as images.