Paragonimiasis Misdiagnosed as Pulmonary Tuberculosis: A Case Report

Area of Science:

• Medical Parasitology
• Infectious Diseases
• Public Health

Background:

• Paragonimiasis is a parasitic zoonosis transmitted by ingesting undercooked crustaceans infected with Paragonimus spp. metacercariae.
• Cajamarca, Peru, is an endemic region for paragonimiasis, a parasitic lung disease.
• Tuberculosis (TB) is prevalent in Peru, often leading to misdiagnosis of similar respiratory conditions.

Observation:

• A 29-year-old man from San Martín, Peru, presented with a three-year history of cough, chest pain, fever, and hemoptysis.
• Initial treatment for tuberculosis (TB) was administered despite negative sputum acid-fast bacillus (AFB) results, due to clinical presentation and regional TB prevalence.
• The patient showed no clinical improvement after eight months of TB treatment.

Findings:

• Referral to a regional hospital led to the identification of Paragonimus eggs in sputum cytology.
• The patient received triclabendazole treatment for paragonimiasis.
• Significant clinical and radiological improvement was observed following antiparasitic treatment.

Implications:

• This case highlights the importance of considering paragonimiasis in patients presenting with persistent respiratory symptoms, especially those mimicking tuberculosis.
• Diagnostic considerations should include patient dietary habits, particularly the consumption of raw or undercooked crustaceans, even outside known endemic areas.
• Prompt diagnosis and appropriate antiparasitic treatment are essential for managing paragonimiasis and improving patient outcomes, preventing prolonged misdiagnosis and ineffective treatments.