Infect Chemother.  2012 Dec;44(6):522-525. 10.3947/ic.2012.44.6.522.

Praziquantel Treatment of an Eosinophilic Pleuritis Patient Suspected to Be Due to Sparganum Infection

• Choi MH
• Kim HT
• Kwak TY
• Eom SH
• Kim YS
• Kwak DH
• Kim JH

• KMID: 1806947
• DOI: http://doi.org/10.3947/ic.2012.44.6.522

Abstract

Human sparganosis is caused by the larval tapeworm of genus Spirometra. This parasite commonly invades subcutaneous tissues and muscles. However, infection in the pleural cavity is rare. A 65-year-old male patient, who had undergone surgical excision of subcutaneous masses due to a parasite infection (presumed to have been sparganosis) approximately 10 years ago, showed pleural effusion and peripheral eosinophilia. The anti-sparganum specific IgG antibody levels in the serum and pleural fluid were significantly higher than the normal control levels. Three consecutive doses of praziquantel (75 mg/kg/day) were administered for control of pleural effusion and peripheral eosinophilia. In this patient, sparganosis was suspected, and the probable cause of the infection was ingestion of raw snakes and frogs. Immunoserologic tests using ELISA can be helpful in diagnosis of pleural sparganosis and praziquantel is suggested as an alternative treatment for surgically unresectable cases.

Keyword

Eosinophilic pleuritis; Sparganosis; Praziquantel

MeSH Terms

Cestoda
Eating
Enzyme-Linked Immunosorbent Assay
Eosinophilia
Eosinophils
Humans
Immunoglobulin G
Male
Muscles
Parasites
Pleural Cavity
Pleural Effusion
Pleurisy
Praziquantel
Snakes
Sparganosis
Sparganum
Spirometra
Subcutaneous Tissue
Immunoglobulin G
Praziquantel

Figure

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  Figure 1 Two post-excision scars on the right flank, measuring 4 cm in length.

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  Figure 2 (A) An initial chest radiograph showing right-sided pleural effusion. (B) A follow-up chest radiograph one month after praziquantel treatment showing disappearance of right-sided pleural effusion.

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  Figure 3 Chest CT shows irregular pleural thickening with subpleural fibrosis at praziquantel the posterior basal segment of the right lower lobe (arrow).

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  Figure 4 (A) Cytology of the pleural fluid showing many eosinophils in the necrotic background (Papanicolaou stain, ×400). (B) A pleural biopsy shows numerous eosinophil infiltration with fibrinoid necrosis (H&E stain, ×400).

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  Figure 5 Clinical courses at first, after 30 and 60 days. ○, eosinophil count; □, total IgE; hatched column, specific antibody titer in serum; dotted column, specific antibody titer in pleural effusion.

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