Korean J Intern Med.  2015 Jan;30(1):56-61. 10.3904/kjim.2015.30.1.56.

Pleural fluid characteristics of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis

• Hwang KE
• Song HY
• Jung JW
• Oh SJ
• Yoon KH
• Park DS
• Jeong ET
• Kim HR

• KMID: 2129664
• DOI: http://doi.org/10.3904/kjim.2015.30.1.56

Abstract

BACKGROUND/AIMS
Pleuropulmonary paragonimiasis produces no specific symptoms or radiologic findings, allowing for the possibility of misdiagnosis. We evaluated the specific clinical and pleural fluid features of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis.
METHODS
We retrospectively analyzed the clinical and radiologic characteristics of 20 patients diagnosed with pleuropulmonary paragonimiasis between 2001 and 2011.
RESULTS
In total, 17 patients presented with respiratory symptoms, including dyspnea (30%), hemoptysis (20%), cough (20%), and pleuritic chest pain (15%). Chest radiographs revealed intrapulmonary parenchymal lesions, including air-space consolidation (30%), nodular opacities (20%), cystic lesions (15%), ground-glass opacities (10%), and pneumothorax (5%). A pleural f luid examination revealed eosinophilia, low glucose levels, and high lactate dehydrogenase (LDH) levels in 87%, 76%, and 88% of the patients, respectively. These traits helped to distinguish pleuropulmonary paragonimiasis from other pleural diseases such as parapneumonic effusion, malignancy, and pleural tuberculosis.
CONCLUSIONS
Pleuropulmonary paragonimiasis is often initially misdiagnosed as other pleural diseases. Therefore, it is important to establish the correct diagnosis. In patients with unexplained pleural effusion living in paragonimiasis-endemic areas, pleural fluid obtained by thoracentesis should be examined to distinguish pleuropulmonary paragonimiasis. When marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid, physicians could consider a diagnosis of pleuropulmonary paragonimiasis.

Keyword

Pleuropulmonary paragonimiasis; Tuberculosis, pleural

MeSH Terms

Adolescent
Adult
Aged
Animals
Biological Markers/analysis
Child
Child, Preschool
Diagnosis, Differential
Enzyme-Linked Immunosorbent Assay
Eosinophilia/diagnosis/parasitology
Female
Glucose/analysis
Humans
L-Lactate Dehydrogenase/analysis
Lung Diseases, Parasitic/*diagnosis/metabolism/parasitology/radiography
Male
Middle Aged
Paracentesis
Paragonimiasis/*diagnosis/metabolism/parasitology/radiography
Paragonimus westermani/*isolation & purification
Pleural Effusion/*diagnosis/metabolism/parasitology/radiography
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed
Tuberculosis, Pleural/*diagnosis
Young Adult
Biological Markers
L-Lactate Dehydrogenase
Glucose