Endocrinol Metab.  2011 Mar;26(1):97-100. 10.3803/EnM.2011.26.1.97.

A Case of Incidentally Diagnosed Adrenal Paragonimiasis

• Park SA
• Lee SH
• Ko SH
• Kim JG
• Park SY
• Yoo JY
• Nam HW
• Ahn YB

• KMID: 2169133
• DOI: http://doi.org/10.3803/EnM.2011.26.1.97

Abstract

We report here on a rare case of adrenal paragonimiasis that presented with an adrenal incidentaloma. A 52-year-old male presented with fatigue and weight loss. The laboratory findings revealed eosinophilia (8.5%) and an increased eosinophil count (910/microL). The computed tomography scan showed 6.5 x 5 cm sized multilocular cystic mass in the right adrenal gland, which was non-functioning, and cystic lesions with variable sizes were also noted in the abdominal cavity. On the surgical field, whitish patches were spread out in the peritoneum, the omentum, the dome of the liver and the diaphragm. The right adrenal gland was replaced by a cystic mass filled with mucopurulent creamy materials. The pathologic findings revealed numerous eggs of Paragonimus spp. Also, the ELISA was positive for IgG paragonimus antibody. The adrenal gland can become infected by various microbial pathogens, including parasites, although it is relatively uncommon. However, in the case of a cystic adrenal mass with accompanying eosinophilia in an endemic area, clinicians should consider the possibility of parasitic infection.

Keyword

Adrenal incidentaloma; Eosinophilia; Paragonimiasis

MeSH Terms

Abdominal Cavity
Adrenal Gland Neoplasms
Adrenal Glands
Diaphragm
Eggs
Enzyme-Linked Immunosorbent Assay
Eosinophilia
Eosinophils
Fatigue
Humans
Immunoglobulin G
Liver
Male
Middle Aged
Omentum
Ovum
Paragonimiasis
Paragonimus
Parasites
Peritoneum
Weight Loss
Adrenal Gland Neoplasms
Immunoglobulin G

Figure

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  Fig. 1 Initial abdominal CT scan. A. Abdominal computed tomography scan showing 6.5 × 5 cm sized multilocular cystic mass (arrow) in the right adrenal gland. B, C. Multiple, variable sized cystic lesions (arrows) were shown in the gastrocolic ligament, transverse mesocolon, and upper omentum areas.

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  Fig. 2 Surgical findings and specimen. A. Whitish patches were disseminated in peritoneum, omentum, dome of liver and diaphragm. B, C. Adrenal gland was replaced by cystic mass filled with mucopurulent creamy materials.

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  Fig. 3 Microscopic examination revealed chronic granulomatous inflammation with central necrosis containing numerous eggs of Paragonimus spp (H&E staining, A, × 100; B, × 400).

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  Fig. 4 Follow-up CT scan 5 months after treatment with praziquantel showed little interval change of cystic lesions (arrow) in the abdominal cavity (A, B).

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