One delayed diagnosis of paragonimiasis case and literature review

Abstract

Human paragonimiasis has been appearing all over the world due to increased human migration, international travel, and worldwide food trading. However, delayed and missed diagnosis rates are also increasing due to atypical clinical manifestations and the lack of disease understanding by clinical workers. We describe the case of a 43-year-old man, who was hospitalized with cough and chest pain for two months. Chest computed tomography (CT) revealed bilateral emphysema, left pleural effusion, and bilateral atelectasis. The hypereosinophilia gave us a clue; ultimately, the diagnosis of paragonimiasis was made through a diet history and a positive result of serum Paragonimus sp. immunoglobulin (Ig) G antibody. Moreover, 27 misdiagnosed paragonimiasis cases in the past decade have been reported. We draw conclusions by summarizing their characteristics for suspicious eosinophilic paragonimiasis patients; we should inquire diet history carefully, test serum IgG antibodies, and try to detect eggs. Once diagnosed, praziquantel is preferred for treatment.

Keywords: Delayed diagnosis; hypereosinophilia; paragonimiasis; praziquantel.

Figure 1

Radiological changes of the patient. On 3 November 2018 (at admission), chest X‐ray showed small amount of pneumothorax with compression of about 10% on the right side and a small quantity of pleural effusion on the left side (A); on 8 November 2018 (the first day of treatment), the computed tomography (CT) showed bilateral pulmonary emphysema (B, C) and left pleural effusion with left lower lobe segmental atelectasis (D, E). On 20 November (10 days after treatment), there was only a little effusion on the left side, less than before (F).