Paragonimiasis - NEJM

An 18-year-old man presented with a 1-year history of episodic hemoptysis. He otherwise felt well, with no dyspnea, fever, night sweats, weight loss, pedal edema, rash, or evidence of bleeding elsewhere. He took no medications. Laboratory examination revealed eosinophilia, with an eosinophil count of 3000 cells per microliter (reference range, 0 to 300). A chest radiograph (Panel A) and an axial computed tomographic image of the chest (Panel B) showed multiple nodules and cavitations (arrows). Eggs from the lung fluke paragonimus were discovered on microscopical examination of bronchoalveolar-lavage fluid (Panel C), confirming a diagnosis of pulmonary paragonimiasis. Paragonimus is acquired by humans through consumption of undercooked freshwater crabs or crayfish. Immature forms migrate through the duodenal wall, peritoneal cavity, and diaphragm to become encapsulated and mature within the pulmonary parenchyma. When the encapsulated cyst bursts, eggs are extruded into the bronchioles and subsequently are coughed up and swallowed, passing back into the environment with the stool. This patient was treated with a course of praziquantel, and the hemoptysis resolved within 2 months.

Marcos Arango Barrientos, M.D.

University of Antioquia School of Medicine, Medellin, Colombia

Alfonso Uriza Carrasco, M.D.
Hospital Universitario San Vicente de Paul, Medellin, Colombia
mabju@yahoo.com