A 54-Year-Old Man Comes to the Emergency Department After Vomiting

A 54-year-old man comes to the emergency department after vomiting blood.  He has also had melena, fatigue, and lethargy over the last 24 hours.  The patient emigrated from sub-Saharan Africa 20 years ago and occasionally returns to visit friends and family.  Temperature is 37.5 C (99.5 F) , blood pressure is 90/60 mm Hg, and pulse is 115/min.  Abdominal palpation reveals an enlarged liver and a spleen tip below the level of the umbilicus.  Laboratory results are as follows: Upper endoscopy reveals bleeding esophageal varices.  Which of the following is the most likely underlying cause of this patient's symptoms?

A) Cysticercosis
B) Hookworm infection
C) Malaria
D) Schistosomiasis
E) Toxoplasmosis

Correct Answer:

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