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Case Reports
. 2011 Jan;1(1):39-41.
doi: 10.4103/2229-5070.72106.

Cerebral paragonimiasis mimicking tuberculoma: First case report in India

T Shantikumar Singh  1 , V Khamo, H Sugiyama
Affiliations
Case Reports

Cerebral paragonimiasis mimicking tuberculoma: First case report in India

T Shantikumar Singh et al. Trop Parasitol. 2011 Jan.

Abstract

An 8-year-old male child of Tuensang District, Nagaland, India, attended Civil Hospital, Tuensang, complaining of cough, fever, headache, and inability to move right arm since one month. On clinical suspicion of tubercular meningitis, anti-tubercular therapy was initiated and the patient was referred to the Naga Hospital Authority. A brain computed tomography scan revealed an isodense area with surrounding edema on the left parietal lobe, which was diagnosed as tuberculoma and the anti-tubercular therapy was continued. As there was no sign of clinical improvement on completion of the three-month-ATD regimen, the patient was investigated for paragonimiasis. Laboratory investigations revealed peripheral blood eosinophilia, raised ESR, Paragonimus egg-positive sputum, and positive Enzyme-linked immunosorbent assay (ELISA) and ID tests for paragonimiasis. The Bacillus Calmette-Guérin (BCG) test and Acid Fast Bacilli (AFB) sputum smears were negative. Chest roentgenogram showed no abnormal findings. A final diagnosis of pulmonary paragonimiasis associated with cerebral paragonimiasis was made. The patient responded to praziquantel therapy. Cerebral paragonimiasis is a serious extrapulmonary form of paragonimiasis, sometimes life-threatening, but curable with praziquantel. It should be included in the differential diagnosis of cerebral granulomatous and other space-occupying lesions.

Keywords: Brain CT Scan; Cerebral paragonimiasis; India; Tuberculoma.

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Conflict of interest statement

Conflict of Interest: None declared

Figures

Figure 1
Figure 1
CT scan of the brain showing an isodense area surrounded by edema (arrow) in the left parietal lobe
Figure 2
Figure 2
Paragonimus egg seen in the sputum smear (40×) not to be scaled
See this image and copyright information in PMC

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