Presentation
Patient with a history of shortness of breath, HRCT shows right tension pneumothorax, multiple nodules, and consolidation patches with signs suggesting central cavitation. In hospitalization, the patient refers to headache. The patient consumes raw crayfish.
Patient Data
Predominantly cystic area, hypointense in T1 Weighted image and hyperintense in T2 weighted image is identified in the region of the left cuneus of 22 x 14 mm with heterogeneous diffusion restriction and presence of a hemosiderin halo. Linear structures that enhance after contrast administration, better visualized on diffusion images, may correspond to the "tunnel" sign caused by a walking adult worm.
The biopsy of the lung of this patient-reported granulomatous reaction surrounding parasites of the paragonimus type.
Courtesy Ximena Cortes MD.
Case Discussion
Paragonimiasis is a lung disease caused by trematodes of genus Paragonimus, endemic in Asia, West Africa, and Latin America. More than 20 species of Paragonimus have been described. The most important species is Paragonimus Westermani.
Paragonimiasis occurs by ingesting undercooked freshwater crayfish, crabs, or shrimp that are infected with encysted larvae. The primary habitat of adult Paragonimus is the lung, and the most severe complication is the erratic migration of paragonimiasis to the brain.
The patient was treated with praziquantel. He was followed months later and demonstrates a good recovery.