Pulmonary paragonimiasis mimicking lung cancer in a tertiary referral centre in Korea

Abstract

Pulmonary paragonimiasis presenting with nodular or mass lesions on CXR is common. Clinicians should therefore include pulmonary paragonimiasis in the differential diagnosis of asymptomatic nodular lesions in the lung in patients who have lived in or travelled to paragonimiasis-endemic areas.

A Case of Delayed Diagnosis of Pulmonary Paragonimiasis due to Improvement after Anti-tuberculosis Therapy

“…Especially, eosinophilia may serve as an important parameter leading to the suspicion of paragonimiasis in the differential diagnosis because of its relatively high sensitivity5,7. Our patient, however, didn't have serum and sputum eosinophilia.…”

“…A report by Kim et al7 suggested that the main features of chest CT scans of pleuropulmonary paragonimiasis were pulmonary nodules, including multiple nodules. Since these clinical manifestations and the radiological appearance of paragonimiasis are similar to those of TB or lung malignancy, the diagnosis is often confused, leading to improper and inadequate treatment3,5,8,9,10,11. In the present case, the lesion of mass-like consolidation with cavitation in the upper lobe led us to consider the findings as reactivated pulmonary TB.…”

“…In the previous reports, the most common manifestation observed was pleural lesions7. According to the reports of one hospital in Korea, however, pleural lesions were relatively rare (28%), and the frequency of intrapulmonary parenchymal lesions was high (72%) compared to the reports of previous studies5,6,7. A report by Kim et al7 suggested that the main features of chest CT scans of pleuropulmonary paragonimiasis were pulmonary nodules, including multiple nodules.…”

“…Infection in humans occurs by ingestion of raw or incompletely cooked freshwater crab or crayfish infected with lung fluke metacercaria5. The classic symptoms of pulmonary paragonimiasis include a chronic cough with rusty-brown sputum, hemoptysis, pleurisy, and fever with radiographic findings of patchy density, linear infiltration, nodules, pleural effusion, and pulmonary cavities5,6. As these clinical manifestations are similar to those of TB or lung malignancy, many paragonimiasis patients are initially treated for other diseases by confusion.…”

“…Peripheral blood examinations show leukocytosis and eosinophilia in many patients with pulmonary paragonimiasis5. Especially, eosinophilia may serve as an important parameter leading to the suspicion of paragonimiasis in the differential diagnosis because of its relatively high sensitivity5,7.…”