Korean J Pediatr.  2008 Jul;51(7):760-765. 10.3345/kjp.2008.51.7.760.

A case of subcutaneous paragonimiasis presented with pleural effusion

• Kim SY
• Park SJ
• Bae SY
• Cho YK
• Kim CJ
• Woo YJ
• Choi YY
• Ma JS
• Hwang TJ

• KMID: 2280265
• DOI: http://doi.org/10.3345/kjp.2008.51.7.760

Abstract

Paragonimiasis is a parasitic infection that occurs following the ingestion of infectious Paragonimus metacercariae from crabs or crayfish. Pulmonary paragonimiasis is the most common clinical manifestation of this infection, but several ectopic paragonimiasis cases have also been reported. Among them, cases of subcutaneous paragonimiasis are rare, especially in children. We report a case of subcutaneous paragonimiasis of the right abdominal wall with pleural effusion with hepatic involvement and without abnormal pulmonary infiltration in a boy aged 2 years and 5 months. He had eaten soybean sauce-soaked freshwater crabs (kejang) 6 months prior to complaining of right abdominal wall distension. On evaluation, right pleural effusion without abnormal pulmonary infiltration was detected, as well as blood eosinophilia, an elevated serum IgE level, pleural fluid eosinophilia and a positive enzyme-linked immunosorbent assay that detected P. westermani antibody in the serum. Thoracentesis, praziquantel administration, and excision of subcutaneous lesions were performed. After treatment, the eosinophil count and serum IgE level were decreased, and the subcutaneous lesions did not recur. The frequency of paragonimiasis has decreased recently, but it is still prevalent in Korea. Paragonimiasis should be suspected if pleural fluid eosinophilia is associated with blood hypereosinophilia and a high level of serum IgE; however clinicians should obtain a thorough history of travel and food habits.

Keyword

Subcutaneous paragonimiasis; Pleural effusion; Paragonimus westermani

MeSH Terms

Abdominal Wall
Aged
Astacoidea
Child
Eating
Enzyme-Linked Immunosorbent Assay
Eosinophilia
Eosinophils
Food Habits
Fresh Water
Humans
Immunoglobulin E
Korea
Metacercariae
Paragonimiasis
Paragonimus
Paragonimus westermani
Pleural Effusion
Praziquantel
Soybeans
Immunoglobulin E
Praziquantel