All issues > Volume 51(7); 2008

Case Report

Korean J Pediatr. 2008;51(7):760-765. Published online July 15, 2008.

A case of subcutaneous paragonimiasis presented with pleural effusion

Soo Young SY Kim¹, Sun Ju SJ Park¹, Si Young SY Bae¹, Young Kuk YK Cho¹, Chan Jong CJ Kim¹, Young Jong YJ Woo¹, Young Youn YY Choi¹, Jae Sook JS Ma¹, Tai Ju TJ Hwang¹

¹Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea

Correspondence Jae Sook JS Ma ,Email: youngcx@hanmail.net

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.

Keywords :Subcutaneous paragonimiasis, Pleural effusion, Paragonimus westermani