1/67. Perirectal cystic paragonimiasis: endorectal coil MRI. We report the transrectal ultrasonographic (TRUS) and endorectal surface coil MR findings for paragonimiasis involving the perirectal space. The patient presented with voiding difficulty. TRUS showed a well demarcated, oval-shaped hyperechoic mass in the perirectal space. On endorectal MR images, the lesion was depicted as a well defined cystic mass with homogeneous intermediate signal intensity on T1-weighted images and heterogeneous hyperintensity on T2-weighted images. Ectopic paragonimiasis can appear as a well defined cystic mass in the peritoneum and should be included in the differential diagnosis of cystic mass in the abdomen and pelvic cavity, including the perirectal space. ( info) |
2/67. Expression of Th1 and Th2 cytokine mRNAs in freshly isolated peripheral blood mononuclear cells of a patient with cutaneous paragonimiasis. Using semiquantitative reverse transcriptase polymerase chain reaction, we examined the levels of various cytokine mRNAs of freshly isolated peripheral blood mononuclear cells (PBMCs) from a cutaneous paragonimiasis patient in the course of successful treatment with praziquantel administration. The pre-treatment levels of Th2 cytokines such as interleukin (IL)-4, IL-5, IL-10 and IL-13 mRNAs in PBMCs of the patient were much higher than those of healthy controls. The levels of IL-4, IL-5 and IL-13 mRNAs slightly elevated on day 2 of the treatment and then declined to the control levels on day 25. The IL-10 mRNA level rapidly decreased after the chemotherapy. In contrast, the mRNA levels of interferon (IFN)-gamma, a Th1 cytokine, remained in the control levels during the course. Peripheral eosinophil counts and levels of total IgE and eosinophil cationic protein in the sera correlated well with the levels of these Th2 cytokine mRNAs. These results suggested the major role of Th2 cytokines in clinical manifestation of human helminthic infection. ( info) |
3/67. Retroperitoneal paragonimiasis: a case of ectopic paragonimiasis presenting as periureteral masses. We describe a case of retroperitoneal paragonimiasis presenting as periureteral masses. CT showed a conglomerate of enhancing nodules with subtle low attenuation in the center at the left iliac fossa and clustered, ring-like, enhancing lesions at the left renal hilum. When a retroperitoneal conglomerate of ring-like, enhancing lesions in association with pleuropulmonary disease suggestive of paragonimiasis can be found in endemic regions or in migrants from those regions, one may expect ectopic-retroperitoneal paragonimiasis. ( info) |
4/67. North American paragonimiasis. A case report. BACKGROUND: paragonimiasis is a parasitic infection with a predilection for pulmonary involvement. Paragonimus species occur throughout the world and exist in nature in a snail-crustacean-mammalian life cycle. Human disease is most frequently encountered in cultures that ingest raw or undercooked crustaceans. North American paragonimiasis, caused by an endemic Paragonimus species, Paragonimus kellicotti, predominantly causes disease in carnivorous and omnivorous animals but may cause human disease if the intermediate host, the crayfish, is ingested raw or undercooked. CASE: A previously healthy, 21-year-old male was infected with P kellicotti and developed parasitic hemoptysis. The disease was contracted through the ingestion of local, undercooked crayfish. diagnosis was established through the morphologic examination of eggs in the cytologic preparation of bronchioalveolar lavage fluid. The patient was successfully treated with praziquantel and recovered without incident. CONCLUSION: paragonimiasis is a cause of parasitic hemoptysis worldwide. paragonimiasis is infrequently encountered in north america and is usually not considered in the differential diagnosis of hemoptysis unless specific risk factors are known. The cytologist or cytopathologist, therefore, may be the first to encounter the diagnostic eggs and should be familiar with this disease. ( info) |
5/67. paragonimiasis westermani with multifocal lesions in lungs and skin. We report a case of paragonimus westermani infection with a reticulonodular lesion in the right lung, left pleural effusion, and a mobile subcutaneous mass. Analyses of pleural effusion and bronchoalveolar lavage fluid (BALF) showed marked eosinophilia and high levels of eosinophil cationic protein and interleukin (IL)-5. Transbronchial lung biopsy revealed the presence of pneumonia with mild eosinophilic infiltration but remarkable lymphocytic infiltration. In this patient, high IL-5 levels in both BALF and pleural effusion could explain the remarkable eosinophilia. ( info) |
6/67. paragonimiasis miyazakii associated with bilateral pseudochylothorax. A 37-year-old man who suffered from bilateral pleural effusions, subcutaneous abdominal induration and blood eosinophilia, was admitted to our hospital. He had ingested raw crabs at a pub-restaurant before the onset of his symptoms. His pleural effusions were chyliform containing cholesterol crystals, and a high level of immunoglobulin e (36,580 IU/ml) and anti-Paragonimus miyazakii antibody were detected. He was effectively treated with praziquantel. This case suggests that paragonimiasis should be strongly suspected if blood eosinophilia, pseudochylothorax, and a high level of immunoglobulin e in pleural effusion are detected. ( info) |
7/67. A case of chronic cerebral paragonimiasis westermani. We report a chronic cerebral paragonimiasis from a 41-year-old Korean man who complains a headache and weakness of left motor neuron components. Magnetic resonance images of the brain revealed conglomerates of multiple ring-like enhancements in temporo-occipital and frontal lobes of the right hemisphere. An intradermal test for paragonimiasis westermani was positive. The patient was born near an endemic area of paragonimiasis and used to eat boiled or grilled freshwater crayfish in his childhood. Nodules in the brain were resected through craniotomies. The eggs of P. westermani were identified pathologically and parasitologically in the calcified necrotic lesions. Examinations on sputum and fecal specimens for the eggs of P. westermani were shown to be negative and a chest radiograph was normal. It is presumed that the brain lesions were formed by P. westermani approximately 30 years ago. ( info) |
| A 36-year-old Korean man presented with a history of epilepsy. MR imaging of the brain revealed multiple conglomerated round nodules that were hypointense on both T1-and-T2 weighted images. These were located at the left temporal and occipital lobes and had surrounding encephalomalacia. CT scan confirmed the presence of large calcified nodules in the corresponding regions. These imaging findings were typical of chronic cerebral paragonimiasis.The clinical, CT and MR features of cerebral paragonimiasis are reviewed. ( info) |
9/67. Primary lung cancer occurring concomitantly with the cicatrized and calcified ova of a parasite: report of a case. We report herein a rare case of primary lung cancer that occurred concomitantly with the calcified ova of a parasite. A 58-year-old man was referred to our department after a pulmonary abnormal shadow had been seen on a chest X-ray done at mass screening. A transbronchial lung biopsy (TBLB) revealed the calcified ova of a parasite. Because the possibility of concomitant lung cancer could not be ruled out, a lung biopsy was taken via video-assisted thoracic surgery (VATS). The pathological diagnosis was squamous cell carcinoma, and a left upper lobectomy was serially performed through a posterolateral thoracotomy. The patient recovered uneventfully and has remained in good health without any sign of recurrence for over 9 months. Following this case report, we review three other cases of this unusual disease combination documented in the literature. ( info) |
10/67. Just another hemoptysis or a fluke? Hemopytsis is commonly encountered in the daily practice of the pulmonary physician. Younger patients with normal chest x-rays frequently have acute or chronic bronchial disease accounting for their complaint. Occasionally parasitic disease is described as an unusual cause for a patient presenting with hemoptysis. Although pulmonary paragonimiasis is unusual in this country, because of the rapid growth in travel as well as immigration, physicians will need to be aware of this disorder. ( info) |