Paragonimiasis presenting as pyopneumothorax with direct visualization of live worms via video-assisted thoracoscopic...

Paragonimiasis is a food-borne zoonotic parasitic disease caused by Paragonimus species, mainly acquired through ingestion of raw or undercooked freshwater crustaceans. Owing to its non-specific clinical manifestations, this disease is often misdiagnosed as pulmonary tuberculosis, bacterial pneumonia, or lung cancer.

The patient was a 54-year-old male who initially presented with pyopneumothorax, along with a history of raw food consumption, chest wall subcutaneous nodules, peripheral eosinophilia, and left-sided pyopneumothorax. Video-assisted thoracoscopic surgery (VATS) was performed, during which live adult Paragonimus worms were directly visualized and extracted; post-operatively, the patient received praziquantel for antiparasitic treatment. He achieved complete recovery following VATS debridement combined with praziquantel therapy.

This case underscores the diagnostic challenges posed by atypical pleural Paragonimiasis and highlights that VATS has important dual diagnostic and therapeutic value for highly suspected cases with inconclusive non-invasive workup in endemic regions, while serological testing and parasite ova detection remain first-line confirmatory methods for typical cases.