Answer to February 2014 Photo Quiz

Abstract

Answer: Paragonimiasis. The fiber optic bronchoscopy examination revealed swelling mucosa on the inner wall of the right upper lobe, and paragonimus eggs were found in the bronchoalveolar lavage fluid (BALF) under a microscope. We also found that eosinophil counts were increased in the BALF (15%) and were normal in the blood. A blood sample was also immediately sent to the National Institute of Parasitic Disease Prevention and Control, and a diagnosis of paragonimiasis was subsequently confirmed by a multidot enzyme-linked immunosorbent assay (ELISA). Our patient had no definite history of eating raw crab fossil or crayfish, but he liked to eat sashimi. And his condition was controlled after treatment with praziquantel (total dose, 150 mg/kg of body weight). As a zoonotic helminthiasis, paragonimiasis was widely found in China before the 1950s, but now the disease is rarely found. It can be caused by eating raw or undercooked infectious paragonimus metacercariae (such as crab fossil and crayfish) or drinking unboiled water in the areas of endemicity. Typical pulmonary paragonimiasis patients develop fever, chest pain, and respiratory symptoms, including chronic cough with hemoptysis. However, the clinical presentations of pulmonary paragonimiasis are complicated and are frequently indistinguishable from those of pneumonia, pulmonary tuberculosis (1), and lung cancer (2,–4). To conclude, paragonimiasis should be considered when a patient has fever, cough, and a patch shadow in the chest X-ray scan but does not respond to antibiotic treatment. (See page 383 in this issue [doi:10.1128/JCM.03425-12] for photo quiz case presentation.)