Korean J Parasitol.  2017 Jun;55(3):313-317. 10.3347/kjp.2017.55.3.313.

A Case of Ectopic Peritoneal Paragonimiasis Mimicking Diverticulitis or Abdominal Abscess

Affiliations
  • 1Department of Infectious Diseases, Asan Medical Center, Seoul 05505, Korea. drchong@amc.seoul.kr
  • 2Department of Surgery, Asan Medical Center, Seoul 05505, Korea.
  • 3Department of Radiology, Asan Medical Center, Seoul 05505, Korea.
  • 4Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul 07049, Korea.
  • 5Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.

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.

Keyword

Paragonimus westermani; paragonimiasis; peritoneaum; abscess; parasite egg
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