A case of cutaneous paragonimiasis presented with minimal pleuritis
A 3.5-year-old male child from Senapati district in Manipur reported with intermittent low-grade fever, occasional non-productive cough, and mild chest pain since 6 months. There was no history of contact with known case of pulmonary tuberculosis. Physical examination revealed no abnormal findings except a diffuse subcutaneous swelling on the left posterior chest wall which was detected incidentally. The swelling was first noticed on the left upper quadrant of the abdominal wall then migrated through the right anterior chest wall to the posterior surface of left chest. The nodule measuring 4 cm in diameter was firm, non-tender and without any sign of inflammation. Chest X-ray showed no abnormal features except mild pleural reaction and thickening in both sides. Mantoux test was negative. His CBC (complete blood count) showed hemoglobin-11.8%, TLC (Total leucocyt count)-14,000/cu mm, Neutrophils-60%, Lymphocytes-28%, Monocytes-2%, Eosinophils-10% and ESR (Erythrocyte sedimentation rate)- 50 mm at the end of 1st h (Westergren's method). Stool examination for parasite ova and cyst by formol ether sedimentation technique for 3 consecutive days was negative. Aspiration cytology showed eosinophilic granulomatous exudate, leucocytes, and Charcot-Leyden crystals. Further history of dietary habit revealed that the child was non-vegetarian and had consumed smoked and fried crabs collected by the parents from the local mountain streams. On clinical suspicion serological test for paragonimiasis was advised. Dot Immunogold Filtration Assay (DIGFA) test for paragonimiasis was positive []. The case was finally diagnosed as cutaneous paragonimiasis with pleuritis. A course of Praziquantel at 25 mg/kg body weight three times a day for 3 days was prescribed. The swelling as well as respiratory symptoms gradually disappeared after the therapy.