Cerebral paragonimiasis. Case report--CT scan findings, early diagnosis and treatment-- (author's transl)

Abstract

The authors report a case of cerebral paragonimiasis in an 8-year-old boy who was admitted to the hospital due to epileptic fits and left hemiparesis. The patient had eaten raw wild boar meat, which is said to play a role of paratenic host of Paragonimus westermani, 3 months prior to the symptoms. Skull X-ray, carotid angiography, and electroencephalography did not suggest cerebral paragonimiasis. CT scan and the use of intravenous contrast medium showed multiple round and/or oval rings with “soap bubble” appearances in the right parietal area. The band specific to Paragonimus westermani was identified in immunoelectrophoresis and skin test was also positive. There was remarkable eosinophilia in the circulating blood. Thus, the diagnosis of cerebral paragonimiasis was rendered and one course of Bithionol was started. This, however, failed to improve clinical symptoms and signs. A right parietal craniotomy was then performed and multiple encapsulated masses were removed from the right parietal lobe. Surgical specimen contained eggs of Paragonimus westermani and a great number of Charcot-Leyden crystals. Postoperatively another course of Bithionol was provided. Clinical symptoms and signs improved remarkably and the patient was discharged at the 47th postoperative day. It is emphasized that the combination of CT scan and immunological examinations was quite valuable in the diagnosis. This may be the first case of cerebral paragonimiasis diagnosed in such a relatively early stage by CT scan.