Brain hemorrhage associated with a mixed parasitic infection in a foreign technical intern trainee: A case report

In recent years, the number of foreign technical intern trainees in Japan has been steadily increasing. As a result, opportunities to treat foreign patients with different cultures and customs have also increased and so has the possibility of encountering cases that have not been previously experienced. We report a case of a 25-year-old Cambodian man who is residing in Japan as a technical intern trainee. He presented with a chief complaint of headache and dizziness. After further examination, a diagnosis of intracerebral hemorrhage was made. Blood tests revealed peripheral eosinophilia, and chest computed tomography showed multiple abnormal findings, leading to the suspicion of a parasitic infection. Detailed medical history revealed a dietary history suggestive of a parasitic infection. Further, he tested positive for serum and cerebrospinal fluid antibodies against Paragonimus species and serum antibodies against liver fluke. Based on these findings, a diagnosis of a mixed infection with both parasites was made, and the intracerebral hemorrhage was determined to be due to paragonimiasis. The patient was treated with oral praziquantel, which resulted in a favorable outcome. Our experience with this case suggests that when treating foreign patients, it is essential to be mindful of their culture and customs, and that detailed questioning, including queries on lifestyle habits, can sometimes lead to an early diagnosis, making it an important step in patient care.