A Case of Pleural Paragonimiasis Confused with Tuberculous Pleurisy

Abstract

Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.

Pleuropulmonary Paragonimiasis with Multiple Nodules in the Pleura

“…It has been repeatedly demonstrated that pleural fluid of paragonimiasis is eosinophilic and shows increased levels of total protein, LDH, and ADA and decreased levels of glucose (7,8,13), which was consistent with the present findings. It is noteworthy that, for paragonimiasis, both the macroscopic and microscopic features of the pleura as well as the laboratory examinations of pleural effusion resemble those of tuberculosis (7,14,15). Among patients with paragonimiasis, the frequency of a misdiagnosis and/or treatment for tuberculosis has been found to be 44.4-59.0% (16)(17)(18)(19).…”

“…Whether or not the white dot lesions were the same as the nodules in our case is unclear, as there was no picture of the pleura in the literature (12). Contrary to macroscopic imaging findings, the histopathological findings of the pleural nodules in the present case were similar to those of previous reports (7,8), which demonstrated necrotizing granulomas. The differences in the visual characteristics of the pleura between previous cases and our own may be due to variations in the length of the clinical course; the present patient underwent thoracoscopy only one month after the ingestion of fluke-infested raw meat, whereas the time intervals of the others were at least several months.…”

“…Pleural effusion is one of the most common manifestations of paragonimiasis, whose frequency has been reported as high as about 70% (5,10,11). There have been four cases of paragonimiasis in which diagnostic or surgical thoracoscopy was performed; on thoracoscopy, three of them showed only a fibrous peel covering the pleura (6)(7)(8), and the other showed pleural thickening with some white dots (12). Whether or not the white dot lesions were the same as the nodules in our case is unclear, as there was no picture of the pleura in the literature (12).…”

“…Pleural effusion is one of the major and typical characteristics of the early phase of paragonimiasis (2)(3)(4)(5). Nevertheless, there have been few cases of pleuropulmonary paragonimiasis reported with thoracoscopic findings, most of which showed only diffuse fibrin deposition due to empyema (6)(7)(8); little is known about the visual features of the pleura of early-stage paragonimiasis.…”

Pneumonien mit Reiseanamnese

“…Radiologisch erscheint die Wurmzyste mit perizystischer Infiltration als rundes Infiltrat, im CT als Ringstruktur [26]. Auch Pleuraergüsse können auftreten [27]. Die Diagnose wird bestätigt durch den Ei-Nachweis in Sputum, ggf.…”