A paragonimiasis patient with allergic reaction to praziquantel and resistance to triclabendazole: successful treatment after desensitization to praziquantel

Abstract

Paragonimiasis is an infectious disease caused by trematodes of the genus Paragonimus. This trematode can be treated successfully with praziquantel in more than 90% of the cases. Although praziquantel is generally well tolerated, anaphylactic reactions to this drug have been reported in a few cases. We report here a 46-year-old Korean female with paragonimiasis, presumed to be due to Paragonimus westermani, who displayed an allergic reaction to praziquantel and resistance to triclabendazole treatment. The patient was successfully treated with praziquantel following a rapid desensitization procedure. Desensitization to praziquantel could be considered when no alternative drugs are available.

Keywords: Paragonimus; desensitization; drug allergy; paragonimiasis; praziquantel; triclabendazole.

Fig. 1

CT scan of the chest of a 46-year-old female diagnosed with P. westermani showed an approximately 3.2×2.8 cm sized heterogeneously enhanced mass-like consolidation (arrow) in the anterior segment of the right upper lobe, which was attached to the mediastinal pleura.

Fig. 2

Histologic findings of percutaneous needle biopsy specimens from the lung showed abundant inflammatory cells, including many eosinophils, some granulomas, and necrotic cellular debris. H-E stain, ×400.

Fig. 3

The changes of the percentage of eosinophils and anti-P. westermani IgG antibody titer over time in a 46-year-old female who was diagnosed with P. westermani and received treatments with triclabendazole and praziquantel. The anti-P. westermani IgG titers as measured by micro-ELISA are expressed as the optical density at 405 nm.