Paragonimiasis: An Unexpected Cause of Cardiac Tamponade

Abstract

SESSION TITLE: Lung Infections 2 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 11:00 AM - 12:00 PM INTRODUCTION: Paragonimiasis (lung fluke disease) is a potentially serious infection caused by lung fluke of the genus Paragonimus. It is endemic in Asia and Africa. In the United States (US), the disease is observed most frequently in immigrants from endemic countries, but local transmission has been described. CASE PRESENTATION: A 53 year- old man presented to an emergency department in the Mid-Atlantic United States complaining of a productive cough, shortness of breath, chest pain, abdominal bloating and diarrhea. A review of systems was notable for fatigue, weight loss and night sweats. His past medical history was significant only for hypertension. He grew up in East Africa and later immigrated to the US. He was afebrile, tachycardic and normotensive. Heart sounds were distant. A complete blood count showed a normal white cell count with normal eosinophil count. A comprehensive metabolic panel was normal. Stool was negative for ova and parasites. Chest radiography showed an enlarged heart. Computed tomography of the chest and abdomen showed a large pericardial effusion, small right pleural effusion, numerous small pulmonary nodules, and mass in the spleen (Figure 1). An echocardiogram showed signs of cardiac tamponade. The patient underwent urgent placement of a pericardial window. Pericardial fluid, pleural fluid and bronchoalveolar lavage were negative for bacteria, virus, acid fast bacilli, fungus and malignant cells. A transbronchial biopsy was non diagnostic. An open lung biopsy was performed, which revealed the presence of eggs consistent with Paragonimus. The patient was started on praziquantel after which his symptoms gradually resolved. DISCUSSION: Paragonimiasis may mimic a number of diseases, especially tuberculosis and neoplasm. Cough, hemoptysis, and pleural effusions are common. Diagnosis may require open lung biopsy. Pericardial infiltration, especially to the extent that cardiac tamponade develops, is quite rare. To our knowledge, this is the first reported case of paragonimiasis-induced cardiac tamponade in the US. CONCLUSIONS: Paragonimiasis is a rare cause of lung disease in the US. However, because of immigration from endemic areas and local spread of the disease, it is occasionally encountered in clinical practice. Because many clinical and radiographic abnormalities are non-specific, physicians must maintain a high index of suspicion. Reference #1: Gary Procop. North American Paragonimiasis. Clin Microbiol Rev. 2009 Jul; 22(3): 415-446 DISCLOSURE: The following authors have nothing to disclose: Abdalsamih Taeb, Joshua Sill No Product/Research Disclosure Information