Department of Neurorogical Surgery, Nihon University School of Medicine, Tokyo, Japan.
Department of Pathology, Nihon University School of Medicine, Tokyo, Japan.
Neuropathology. 2022 Aug;42(4):323-328. doi: 10.1111/neup.12841. Epub 2022 Jun 20.
Paragonimiasis is a parasitic disease caused by Paragonimus westermani infection, and migration to the brain results in cerebral paragonimiasis. Cerebral paragonimiasis is now extremely rare, but a few cases are still reported. A 48-year-old Japanese woman presented with right-hand convulsion, right-hand numbness, sputum, and fatigue. Chest computed tomography demonstrated multiple nodular lesions, and head computed tomography revealed a hemorrhagic lesion in the left motor cortex. Magnetic resonance imaging revealed multiple small ring-shaped lesions with surrounding edema. Laboratory evaluation demonstrated peripheral eosinophilia. We considered eosinophilic granulomatosis with polyangiitis and started steroid treatment as a diagnostic therapy since we wanted to avoid cerebral lesion biopsy if possible. However, the patient underwent craniotomy surgery after steroid treatment for four months because a new intracerebral mass lesion had appeared. Trematode eggs were detected in the sample, and the final diagnosis was cerebral paragonimiasis. The patient was successfully treated with praziquantel. Cerebral paragonimiasis is extremely rare but should be considered in the differential diagnosis if atypical intracranial hemorrhage and peripheral eosinophilia are observed.
并殖吸虫病是由卫氏并殖吸虫感染引起的寄生虫病，其向脑部迁移可导致脑并殖吸虫病。脑并殖吸虫病现在极为罕见，但仍有少数病例报告。一位 48 岁的日本女性因右手抽搐、右手麻木、咳痰和疲劳而就诊。胸部计算机断层扫描显示多个结节性病变，头部计算机断层扫描显示左运动皮层有出血性病变。磁共振成像显示多个带有周围水肿的小环形病变。实验室评估显示外周血嗜酸性粒细胞增多。我们考虑嗜酸性肉芽肿伴多血管炎，并开始进行类固醇治疗作为诊断性治疗，因为我们希望尽可能避免脑病变活检。然而，在类固醇治疗四个月后，患者因出现新的颅内肿块病变而行开颅手术。在样本中检测到吸虫卵，最终诊断为脑并殖吸虫病。该患者使用吡喹酮成功治疗。脑并殖吸虫病极为罕见，但如果观察到非典型颅内出血和外周血嗜酸性粒细胞增多，应考虑进行鉴别诊断。
