A Case of Paragonimiasis in the Abdominal Subcutaneous Tissue with Pleural Effusion.

Im, So Hi; Shin, Sung Hwan; Song, Myung Jun; Kim, Jin Woo; Kim, Seung Joon; Lee, Sook Young; Kim, Young Kyoon; Park, Sung Hak

doi:2004.56.5.550

Tuberc Respir Dis > Volume 56(5); 2004 > Article

Case Report

Tuberculosis and Respiratory Diseases 2004;56(5):550-554.
DOI: https://doi.org/10.4046/trd.2004.56.5.550 Published online May 1, 2004.

A Case of Paragonimiasis in the Abdominal Subcutaneous Tissue with Pleural Effusion.

So Hi Im, Sung Hwan Shin, Myung Jun Song, Jin Woo Kim, Seung Joon Kim, Sook Young Lee, Young Kyoon Kim, Sung Hak Park

Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea. youngkim@catholic.ac.kr

Abstract

A paragonimiasis infestation is caused by the paragonimus species. It is commonly found in the lung but has also been found to exist extrapulmonary infestations including cerebral, spinal, subcutaneous, hepatic, splenic, abdominal, urinary, and gynecologic infestation. On the other hand, a cutaneous infestation is extremely rare. Human infestation is caused by ingesting raw or undercooked intermediate hosts. Because paragonimus westermani larva mature to an adult worm in the lung, the possibility of identifying the adult worm of paragonimus westermani at extrapulmonary region is very rare. CASE: After ingesting a fresh-water crab 1 month prior to the hospital visit, a 45-year old female patient was suffering from right pleuritic chest pain during that 1 month. The patient also complained of a palpable mass that was movable and migrating, and it was localized at the right upper quadrant of the abdomen. The eosinophil fraction of the white blood cell of peripheral blood and pleural fluid was elevated to 55.1% and 90%, respectively. Parasite eggs were not found in her sputum and stool examination. By using the enzyme-linked immunosorbent assay (ELISA), the paragonimus-specific IgG antibody titer was elevated to 0.28. During incisional biopsy, we were able to find the young adult worm of paragonimus westermani. We experienced the rare case of ectopic paragonimiasis with pleural effusion that was confirmed by identifying the adult worm of paragonimus westermani within the abdominal subcutaneous tissue. We report a case with brief literature reviews.

Key Words: Extrapulmonary paragonimiasis, Pleural effusion, Subcutaneous mass

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