A Case of Ectopic Peritoneal Paragonimiasis Mimicking Diverticulitis or Abdominal Abscess

Abstract

Paragonimiasis is a parasitic disease caused by Paragnonimus species. The primary site of infection is the lung, and extrapulmonary involvement is also reported. When infected with Paragonimus westermani, which is the dominant species in Korea, the central nervous system is frequently involved along with the liver, intestine, peritoneal cavity, retroperitoneum, and abdominal wall. Ectopic paragonimiasis raises diagnostic challenge since it is uncommon and may be confused with malignancy or other inflammatory diseases. Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain. The patient developed abdominal pain 3 times for the previous 3 years and the computed tomography (CT) of the abdomen revealed fluid collection with wall enhancement. Recurrent diverticulitis was initially suspected and part of the ascending colon was resected. However, the specimen showed intact colon wall without evidence of diverticulitis and multiple parasite eggs and granulomas were found instead. The size of about 70 μm, the presence of an operculum and relatively thick egg shell suggested eggs of Paragonimus species. With appropriate exposure history and a positive antibody test, the definitive diagnosis was made as peritoneal paragonimiasis.

A Paragonimiasis Mimicking Gastric Submucosal Tumor

“…However, in the case of extrapulmonary paragonimiasis, to suspect parasite infection is not easy before pathologic confirmation. Prior studies have reported some extrapulmonary paragonimiasis identified in the abdominal cavity 123. Here we report the first case of paragonimiasis mimicking gastric submucosal tumor.…”

Simultaneous Paragonimus infection involving the breast and lung: A case report

“…Subcutaneous paragonimiasis is rare compared to pulmonary and other ectopic manifestations. Its diagnosis is difficult due to rarity of the disease with various symptoms[9,11]. In the present case, paragonimiasis manifested both in pulmonary and extrapulmonary forms, presenting as a breast mass and a lung nodule.…”

“…When humans are infected, metacercariae can pass through the intestinal wall into the peritoneal cavity and through the diaphragm into the pleural cavity, eventually ending up in the lung parenchyma and finally grow into adult flukes[9]. On its journey to the lungs, the parasite can reach other locations of the body such as the brain, abdomen, skin, heart, and subcutaneous tissues[10].…”

“…ELISA test, an immunodiagnostic method that can detect and measure antibodies in the blood, is known to be both highly sensitive and specific for diagnosing paragonimiasis[9,14]. Infection by Paragonimus can be prevented by not eating raw or undercooked crabs and crayfish.…”

“…Praziquantel is the first-line treatment for human paragonimiasis. It is proven to be highly effective[9,15,16]. To the best of our knowledge, only two cases of paragonimiasis of the breast have been reported so far[6,7].…”