Pediatr Infect Vaccine.  2017 Dec;24(3):178-182. 10.14776/piv.2017.24.3.178.

Pulmonary Paragonimiasis Misdiagnosed with Pulmonary Tuberculosis

• Park SE
• Song B
• Hwang JY

• KMID: 2401393
• DOI: http://doi.org/10.14776/piv.2017.24.3.178

Abstract

Paragonimiasis was one of the most common causes of cavitary lung lesions until the 1960s, but now it has become a very rare disease in Korea. A 16-year-old boy presented with hemoptysis and several days of cough. His plain chest radiograph showed nodular opacity with a cavity in the left upper lung region. Although his symptoms disappeared after taking antituberculous drugs, his plain chest radiograph and computed tomography images after completion of therapy showed a new nodule with a cavity in the left lung field. Through video-assisted thoracoscopic wedge resection, Paragonimus eggs were found in the lung tissues.

Keyword

Lung; Paragonimiasis

MeSH Terms

Adolescent
Cough
Eggs
Hemoptysis
Humans
Korea
Lung
Male
Ovum
Paragonimiasis*
Paragonimus
Radiography, Thoracic
Rare Diseases
Tuberculosis, Pulmonary*

Figure

• 

  Figure 1 (A) Initial chest radiograph shows a subpleural nodule (arrow) in the left upper lung field with localized pleural thickening (arrowhead). Note subtle bubble-like air density within the nodule. (B) Follow-up chest radiograph after completion of antituberculosis medication reveals enlargement of the nodule with increased cavitary portion (arrow) accompanied with pulmonic infiltrates (arrowheads).

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  Figure 2 Serial follow-up of computed tomography (CT). (A) Initial CT scan image shows subpleural air space consolidation and nodule (arrow) with peripheral ground-glass attenuation and tubular shape cavity in the left upper lobe. (B) Follow-up CT scan during antituberculosis medication shows clusters of tiny centrilobular nodules (arrowheads) whereas surrounding ground-glass opacities are resolved. (C) Sagittal image reveals subpleural linear air space consolidation with internal cavitation and surrounding halo of ground-glass attenuation. Note the indentation of the pleura (curved arrow). (D) CT image obtained after completion of antituberculosis medication shows newly appeared nodule with central cavitation (arrow) and increased extent of surrounding ground-glass attenuation (arrowheads).

• 

  Figure 3 Histopathology of video assist thoracoscopic segmentectomy specimen showed scattered eggs of Paragonimus in bronchi and lung parenchymas (A: H&E stain, ×40; B: H&E stain, ×400).

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