Shrivastav Shreya, Jha Anamika
Department of Pathology, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, PO Box 1524, 44600, Nepal.
Department of Radiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Nepal.
Respir Med Case Rep. 2020 Nov 19;31:101298. doi: 10.1016/j.rmcr.2020.101298. eCollection 2020.
Paragonimiasis, or Oriental lung fluke is a parasitic infestation seen in Asia, Africa and South America which is spread by the consumption of crabs and crayfish. To date four cases have been reported from Nepal. Here, we report a case of paragonimiasis in a young male from Kathmandu valley who presented with symptoms of fever, on and off for 1 month, shortness of breath and cough. He was found to have pleural effusion. Sputum examination did not reveal acid fast bacilli, However, based on clinical features, he was started on antitubercular treatment. There was initial improvement, but later, he continued to have cough and hemoptysis over the next 2 years and on subsequent High-Resolution Computerized Tomography (HRCT) he was found to have a cavitary lung lesion in the superior segment of lower lobe of left lung. A possibility of aspergillosis was considered for which he underwent a lobectomy. The gross examination of the lung showed a small cavity measuring 5 mm which revealed on histology a parasitic structure with serous glands within it. In addition, there were many foreign body granulomas with ova within them. A diagnosis of paragonimiasis was made and the patient was started on Praziquantal. He recovered well and is currently asymptomatic. We can learn from this case that the signs and symptoms of paragonimiasis mimic that of tuberculosis and the mistaken diagnosis can lead to unnecessary treatment, prolonged morbidity and loss of time and resources.
肺吸虫病，又称东方肺吸虫病，是一种在亚洲、非洲和南美洲可见的寄生虫感染病，通过食用螃蟹和小龙虾传播。迄今为止，尼泊尔已报告了4例病例。在此，我们报告一例来自加德满都谷地的年轻男性肺吸虫病病例，该患者出现持续1个月的间歇性发热、呼吸急促和咳嗽症状。他被发现有胸腔积液。痰液检查未发现抗酸杆菌，然而，根据临床特征，他开始接受抗结核治疗。起初有改善，但后来，在接下来的2年里他持续咳嗽和咯血，随后的高分辨率计算机断层扫描（HRCT）显示他左肺下叶上段有一个空洞性肺部病变。考虑有曲霉病的可能性，为此他接受了肺叶切除术。肺的大体检查显示一个5毫米的小空洞，组织学检查显示其中有一个带有浆液腺的寄生结构。此外，有许多含有虫卵的异物肉芽肿。诊断为肺吸虫病，患者开始接受吡喹酮治疗。他恢复良好，目前无症状。我们可以从这个病例中学到，肺吸虫病的体征和症状与结核病相似，错误的诊断可能导致不必要的治疗、延长发病时间以及时间和资源的浪费。
