Tuberc Respir Dis.  2014 Apr;76(4):175-178.

A Case of Pleural Paragonimiasis Confused with Tuberculous Pleurisy

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wjkoh@skku.edu
  • 2Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.

Keyword

Adenosine Deaminase; Paragonimiasis; Pleural Effusion; Tuberculosis

MeSH Terms

Adenosine Deaminase
Adult
Chest Pain
Eggs
Humans
Inflammation
Ovum
Paragonimiasis*
Paragonimus
Pleural Effusion
Sensation
Thoracic Surgery, Video-Assisted
Tuberculosis
Tuberculosis, Pleural*
Adenosine Deaminase

Figure

  • Figure 1 A 38-year-old man with pleural effusion who was diagnosed with pleural paragonimiasis. (A) Chest radiography showed pleural effusion. (B) Chest computed tomography showed pleural thickening with pleural effusion. (C) Subpleural consolidation.

  • Figure 2 The resected empyema sac. (A) Gross examination showed that the pleura were thickened by diffuse fibrosis (H&E stain, ×2). (B) Parasitic eggs surrounded by granulomatous inflammation (H&E stain, ×40). (C) Ovoid parasitic eggs with a thick shell in the granuloma (H&E stain, ×200).


Reference

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