Abstract
A paragonimiasis infestation is caused by the paragonimus species. It is commonly found in the lung but has also been found to exist extrapulmonary infestations including cerebral, spinal, subcutaneous, hepatic, splenic, abdominal, urinary, and gynecologic infestation. On the other hand, a cutaneous infestation is extremely rare. Human infestation is caused by ingesting raw or undercooked intermediate hosts. Because paragonimus westermani larva mature to an adult worm in the lung, the possibility of identifying the adult worm of paragonimus westermani at extrapulmonary region is very rare. Case : After ingesting a fresh-water crab 1 month prior to the hospital visit, a 45-year old female patient was suffering from right pleuritic chest pain during that 1 month. The patient also complained of a palpable mass that was movable and migrating, and it was localized at the right upper quadrant of the abdomen. The eosinophil fraction of the white blood cell of peripheral blood and pleural fluid was elevated to 55.1% and 90%, respectively. Parasite eggs were not found in her sputum and stool examination. By using the enzyme-linked immunosorbent assay (ELISA), the paragonimus-specific IgG antibody titer was elevated to 0.28. During incisional biopsy, we were able to find the young adult worm of paragonimus westermani. We experienced the rare case of ectopic paragonimiasis with pleural effusion that was confirmed by identifying the adult worm of paragonimus westermani within the abdominal subcutaneous tissue. We report a case with brief literature reviews.
과거에 비해 최근에는 우리나라에서 기생충 감염의 빈도가 낮아지긴 하였지만, 우리나라에서 비교적 흔한 감염원인 민물 게장등을 섭취한 병력이 있고, 호산구성 흉막 삼출과 말초혈액에서 호산구증다증이 있을 경우, 반드시 기생충 감염의 가능성을 생각해 보아야 한다. 피하조직에서의 폐흡충의 이소기생 례가 빈번한 것은 아니지만, 본 증례와 같이 이동성의 복부 종괴가 있을 경우 조직검사와 면역학적 검사를 통해 기생충 감염 여부에 대한 확인 절차는 반드시 필요하다. 그럼으로써, 결핵이나 폐암등 다른 질환으로의 오진에 의해 발생하는 경제사회적 손실을 최소화할 수 있을 것으로 사료된다.
