North American paragonimiasis is well described in omnivorous and carnivorous animals on this continent. Humans are rarely infected, largely because of dietary customs, but are at risk for infection if raw or undercooked crayfish are consumed. We describe a patient with a pleuropulmonary infection due to Paragonimus kellicotti that presented as recurrent pneumothoraces and a cavitary lesion. This is the first case of North American paragonimiasis in which the diagnosis was based on the morphology of the eggs present in histologic sections.

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A child with incontinentia pigmenti (Bloch-Sultzberger syndrome) had recurrent pneumococcal meningitis and pneumococcal bacteremia with associated subdural hematomas. Immunologic evaluation revealed defective neutrophil chemotaxis with normal neutrophil chemiluminescense. In addition, lymphocytes showed a depressed proliferative response to phytohemagglutinin stimulation. An immunologic defect may prove to be part of this syndrome.

Lichen myxedematosus is a rare, chronic, progressive disease of unknown etiology characterized histologically by mucin deposition in the upper one half of the dermis and is in many cases associated with a serum paraprotein. We report the third case of lichen myxedematosus which has been treated with oral cyclophosphamide. Our case, as one of those previously treated, lacked the characteristic paraprotein. Therapeutic response consisted of improvement, but not complete resolution of the skin findings.