Cutaneous paragonimiasis due to triploid Paragonimus westermani presenting as a non-migratory subcutaneous nodule: a case report

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• 作者：Makoto Kodama (1)
  Mayumi Akaki (1) (2)
  Hiroyuki Tanaka (1)
  Haruhiko Maruyama (3)
  Eiji Nagayasu (3)
  Tetsuhiro Yokouchi (4)
  Yasuji Arimura (5)
  Hiroaki Kataoka (1)
  
  1. Section of Oncopathology and Regenerative Biology ; Department of Pathology ; Faculty of Medicine ; University of Miyazaki ; 5200 Kihara ; Kiyotake ; Miyazaki ; Miyazaki ; 889-1692 ; Japan
  2. Clinical Laboratory ; University of Miyazaki Hospital ; 5200 Kihara ; Kiyotake ; Miyazaki ; Miyazaki ; 889-1692 ; Japan
  3. Division of Parasitology ; Department of Infectious Diseases ; Faculty of Medicine ; University of Miyazaki ; 5200 Kihara ; Kiyotake ; Miyazaki ; Miyazaki ; 889-1692 ; Japan
  4. Yokouchi Dermatology and Plastic Surgery ; 1445-69 Haranomae ; Oshimacho ; Miyazaki ; Miyazaki ; 880-0824 ; Japan
  5. Division of Neurology ; Respirology ; Endocrinology and Metabolism ; Department of Internal Medicine ; Faculty of Medicine ; University of Miyazaki ; 5200 Kihara ; Kiyotake ; Miyazaki ; Miyazaki ; 889-1692 ; Japan
  
• 关键词：Subcutaneous nodule ; Paragonimus westermani ; Histopathology
• 刊名：Journal of Medical Case Reports
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：8
• 期：1
• 全文大小：777 KB
• 参考文献：1. Maruyama, H, Nawa, Y (2007) Haikyuutyuu. Jpn J Chest Dis 69: pp. 269-275
  2. Sasaki, M, Kamiyama, T, Yano, T, Nakamura-Uchiyama, F, Nawa, Y (2002) Active hepatic capsulitis caused by Paragonimus westermani infection. Intern Med 41: pp. 661-663 CrossRef
  3. Seung, HK, Byung, LC, Jung, GI, Myeong, CK, Kyung, MY, Je, GC (1994) Chronic pelvic paragonimiasis: radiological findings. Seoul J Med 35: pp. 289-293
  4. Kradin, RL, Mark, EJ Pulmonary infections. In: Kradin, RL eds. (2010) Diagnostic Pathology of Infectious Disease. Sounders Elsevier, Philadelphiapp. 180
  5. Nagayasu E, Yoshida A, Hombu A, Horii Y, Maruyama H: Paragonimiasis in Japan: a twelve-year retrospective case review (2001鈥?012). / Intern Med in press
  6. Ano, S, Sumi, M, Inage, Y, Fujiwara, M, Kikuchi, N, Ishii, Y, Sekizawa, K (2006) A case of long-duration Paragonimiasis westermani. Jpn J Chest Dis 65: pp. 1130-1136
  7. Mukae, H, Taniguchi, H, Matsumoto, N, Iiboshi, H, Ashitani, J, Matsukura, S, Nawa, Y (2001) Clinicoradiologic features of pleuropulmonary Paragonimus westermani on Kyusyu Island, Japan. Chest 120: pp. 514-520 CrossRef
  8. Lee, CH, Kim, JH, Moon, WS, Lee, MR (2012) Paragonimiasis in the abdominal cavity and subcutaneous tissue: report of 3 cases. Korean J Parasitol 50: pp. 345-347 CrossRef
  9. Kim, EA, Juhng, SK, Kim, HW, Kim, GD, Lee, YW, Cho, HJ, Won, JJ (2004) Imaging findings of hepatic paragonimiasis: a case report. J Korean Med Sci 19: pp. 759-762 CrossRef
  10. Zhang, JS, Huan, Y, Sun, LJ, Zhang, GY, Ge, YL, Zhao, HT (2006) MRI features of pediatric cerebral paragonimiasis in the active stage. J Magn Reson Imaging 23: pp. 569-573 CrossRef
  11. Nakamura, K, Ichiyasu, H, Tokunaga, K, Horio, Y, Tanaka, H, Kohrogi, H (2012) A report on 2 cases of Paragonimus westermani infection caused by eating raw boar meat. J Jpn Soc Respir Endoscopy 34: pp. 552-557
  12. Sugiyama, H, Umehara, A, Morishima, Y, Yamasaki, H, Kawanaka, M (2009) Detection of Paragonimus metacercariae in the Japanese freshwater crab, Geothelphusa dehaani, bought at retail fish markets in Japan. Jpn J Infect Dis 62: pp. 324-325
  13. Dainichi, T, Nakahara, T, Moroi, Y, Urabe, K, Koga, T, Tanaka, M, Nawa, Y, Furue, M (2003) A case of cutaneous paragonimiasis with pleural effusion. Int J Dermatol 42: pp. 699-702 CrossRef
  14. Ashitani, J, Kumamoto, K, Matsukura, S (2000) Paragonimiasis westermani with multifocal lesions in lungs and skin. Intern Med 39: pp. 433-6 CrossRef
  
• 刊物主题：Medicine/Public Health, general; General Practice / Family Medicine; Public Health; Primary Care Medicine;
• 出版者：BioMed Central
• ISSN：1752-1947

文摘

Introduction Paragonimiasis is a food-borne infection caused by Paragonimus parasites. The lungs and pleura are the primary sites for the infection; however, ectopic infection can occur in other organs such as skin, liver and brain. It is difficult to make a diagnosis of ectopic paragonimiasis due to an ignorance of, and unfamiliarity with the disease. We report the case of a patient with subcutaneous paragonimiasis diagnosed by histopathological analysis and serological testing. Case presentation A 39-year-old Chinese immigrant woman presented with a subcutaneous nodule in her left lower back. The nodule was initially suspected of lipoma and she was followed up on without any treatment. However, it gradually indurated and the nodule was resected surgically. A magnetic resonance imaging scan revealed a polycystic lesion with inhomogeneous low or high intensity on T1- or T2-weighted images, respectively. The rim of the lesion was enhanced after contrast enhancement, but the inside did not show high-signal intensity. A histological analysis of the surgically resected specimen revealed variable-sized tubulo-cystic structures. The cyst wall showed a granulomatous change with scant eosinophilic infiltration. A number of parasite ova were observed in the necrotic tissue inside the cysts, and a parasite body with a presumed oral sucker and reproductive organ was also detected, suggesting a trematode infection. A subsequent serological examination showed a positive reaction of her serum to the Paragonimus westermani antigen. No abnormal findings were found on her chest computed tomography scan. The diagnosis of subcutaneous paragonimiasis caused by Paragonimus westermani was made. Conclusions We report a case presenting only as a non-migratory subcutaneous nodule without any pleuropulmonary lesion, which was initially suspected of lipoma but denied by magnetic resonance imaging scan results. The case was subsequently diagnosed as subcutaneous paragonimiasis from the results of histopathological analysis and serological testing.