Abdominal paragonimiasis after consumption of wild boar meat

Abstract

A 60-year-old man presented with a 10-day history of abdominal and back pain. Abdominal contrast-enhanced computed tomography showed an intraperitoneal abscess (Figure 1). Antibiotic therapy with flomoxef resulted in reduced size but not the total disappearance of the abscess. Laparoscopic surgery was performed. In addition to the mass-like structure in the greater omentum (Figure 2A), numerous white nodules were found on the peritoneum (Figure 2B). Pathological examination showed granulomatous inflammation around parasite eggs (Figure 2C and D). The patient had eaten raw wild boar meat 7 months ago. Total serum immunoglobulin E was elevated (433.9 IU/mL), but total white blood cell and eosinophil counts were within the reference intervals. Serological examination revealed a positive reaction to Paragonimus antigens. A diagnosis of abdominal paragonimiasis was made. The patient’s symptoms resolved after the surgery. Praziquantel (75 mg/kg/daily for 3 consecutive days) was administered postoperatively. The patient has been free from symptoms for 3 months of follow-up.Figure 2Laparoscopic view of a mass-like structure (main lesion) with the long diameter of about 30 mm in the greater omentum (A), with white nodules (∼1 mm in diameter) observed on the surface of the peritoneum (B); low-power (C) and high-power (D) microscopic views of the main lesion containing parasite eggs (78 × 49 μm in average size) (Hematoxylin & eosin staining; scale bars: 500 and 50 μm, respectively).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Although the adult Paragonimus primarily inhabits the lung, it may also reach various ectopic sites, including the greater omentum (Jeong et al., 2002Jeong W.K. Kim Y. Kim Y.S. Park D.W. Park C.K. Baek H.K. et al.Heterotopic paragonimiasis in the omentum.J Comput Assist Tomogr. 2002; 26: 1019-1021Crossref PubMed Scopus (10) Google Scholar), and cause extrapulmonary paragonimiasis. Wild boar meat is 1 of 2 major food sources of infection, as in this case, the other is freshwater crabs in Japan (Nagayasu et al., 2015Nagayasu E. Yoshida A. Hombu A. Horii Y. Maruyama H. Paragonimiasis in Japan: a twelve-year retrospective case review (2001-2012).Intern Med. 2015; 54: 179-186Crossref PubMed Scopus (46) Google Scholar). On behalf of all authors, the corresponding author states that there is no conflict of interest.