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Introduction <p>Paragonimiasis, a parasitic infection caused by <i>Paragonimus westermani</i>, is a rare but important differential diagnosis in patients presenting with cavitating lung lesions, especially those from endemic regions. Extrapulmonary involvement is uncommon and can pose significant diagnostic challenges.</p> Patient information <p>A 41-year-old Filipino man, working as a driver, came to the emergency department with a 4-week history of shortness of breath, productive cough with yellowish sputum, fever, and body aches. He had a known history of poorly controlled type 2 diabetes for 4&#xa0;years and was a heavy smoker.</p> Clinical findings <p>On examination, the patient appeared unwell with signs of hypoxemia and fever.</p> Diagnostic assessment <p>Initial investigation for multiple caviraty lesion were done like sputum for AFB. Given his background and travel history from an endemic area, parasitic infection was considered. A wet mount examination of fresh sputum revealed <i>P. westermani</i> ova, confirming the diagnosis. MRI scans of the brain and abdomen were unremarkable, but pelvic MRI revealed a scrotal abscess. The patient underwent surgical drainage of the abscess along with a left inguinal orchidectomy. Interestingly, <i>Paragonimus</i> ova were found in the abscess fluid, but no bacteria were cultured. Histopathology of the excised tissue showed intense inflammation involving the epididymis, spermatic cord, and surrounding tissues, with atrophic changes in the testicle—though no ova were seen in the histological samples.</p> Therapeutic intervention <p>He was started on praziquantel, the standard antiparasitic treatment, and recovered well following surgery.</p> Follow-up and outcomes <p>The patient showed noticeable clinical improvement after treatment.</p> Conclusion <p>This case underscores the importance of considering parasitic infections like <i>P. westermani</i> in patients with cavitary lung disease, particularly when typical causes are excluded. It also illustrates that extrapulmonary manifestations, though rare, can occur and may require surgical intervention. A high index of suspicion, especially in patients from endemic areas, can lead to timely diagnosis and effective management. This is the first case report of pulmonary paragonimiasis in Jubail and complicated by scrotal abscess worldwide.</p>

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Rare case of pulmonary paragonimiasis in Jubail city

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月23日

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  • Salah A. M. Ali,
  • Randa I. Ahmed,
  • Mohamed Deeb,
  • Mahmoud Hassan,
  • Nagwa Shahein,
  • Mohamed Hisham

摘要

Introduction

Paragonimiasis, a parasitic infection caused by Paragonimus westermani, is a rare but important differential diagnosis in patients presenting with cavitating lung lesions, especially those from endemic regions. Extrapulmonary involvement is uncommon and can pose significant diagnostic challenges.

Patient information

A 41-year-old Filipino man, working as a driver, came to the emergency department with a 4-week history of shortness of breath, productive cough with yellowish sputum, fever, and body aches. He had a known history of poorly controlled type 2 diabetes for 4 years and was a heavy smoker.

Clinical findings

On examination, the patient appeared unwell with signs of hypoxemia and fever.

Diagnostic assessment

Initial investigation for multiple caviraty lesion were done like sputum for AFB. Given his background and travel history from an endemic area, parasitic infection was considered. A wet mount examination of fresh sputum revealed P. westermani ova, confirming the diagnosis. MRI scans of the brain and abdomen were unremarkable, but pelvic MRI revealed a scrotal abscess. The patient underwent surgical drainage of the abscess along with a left inguinal orchidectomy. Interestingly, Paragonimus ova were found in the abscess fluid, but no bacteria were cultured. Histopathology of the excised tissue showed intense inflammation involving the epididymis, spermatic cord, and surrounding tissues, with atrophic changes in the testicle—though no ova were seen in the histological samples.

Therapeutic intervention

He was started on praziquantel, the standard antiparasitic treatment, and recovered well following surgery.

Follow-up and outcomes

The patient showed noticeable clinical improvement after treatment.

Conclusion

This case underscores the importance of considering parasitic infections like P. westermani in patients with cavitary lung disease, particularly when typical causes are excluded. It also illustrates that extrapulmonary manifestations, though rare, can occur and may require surgical intervention. A high index of suspicion, especially in patients from endemic areas, can lead to timely diagnosis and effective management. This is the first case report of pulmonary paragonimiasis in Jubail and complicated by scrotal abscess worldwide.