Imported Familial Pulmonary and Cerebral Paragonimiasis in Korea: Cases and Literature Review from a Clinical Grand Round Conference

Abstract

Paragonimiasis, most commonly caused by Paragonimus westermani, is endemic in East and Southeast Asia and commonly transmitted through ingestion of raw or undercooked freshwater crab or crayfish. While pulmonary manifestations predominate, extrapulmonary involvement such as cerebral paragonimiasis can occur. We describe three cases of imported familial pulmonary and extrapulmonary paragonimiasis from Southeast Asia and diagnosed in Korea. A 12-year-old boy presented with dizziness, headache, nausea, and vomiting. Brain magnetic resonance imaging revealed a hemorrhagic mass-like lesion with leptomeningeal enhancement, and chest tomography showed serpiginous tubular opacities with multifocal consolidations. Laboratory evaluation revealed marked eosinophilia (46.2%). Further history revealed habitual consumption of raw crayfish while residing in Cambodia. Serology was positive for P. westermani and Clonorchis sinensis IgG. Treatment with albendazole and praziquantel resulted in resolution of symptoms and normalization of eosinophil counts. Further evaluation identified similar findings in his parents who were misdiagnosed as tuberculosis and cerebral hemorrhage, and the family was treated with praziquantel. This familial cluster highlights the importance of detailed dietary and travel history in patients with eosinophilia and neurological symptoms. This case was discussed at the Clinical Grand Round of the Korean Society of Infectious Diseases on November 7, 2024.