High-throughput sequencing of bronchoalveolar lavage fluid confirms pulmonary paragonimiasis: A case report.
Paragonimiasis, a rare parasitic disease, often presents diagnostic challenges due to its insidious onset, multiorgan involvement, and nonspecific clinical manifestations, frequently leading to misdiagnosis. While numerous reports describe diagnostic errors in paragonimiasis management, cases involving repeated misdiagnoses across multiple tertiary hospitals over 2 years (particularly with comprehensive epidemiological evidence of freshwater crab consumption) remain exceptionally uncommon. We herein present such a noteworthy case.
A 45-year-old male was hospitalized 5 times across 4 tertiary centers in Guilin (January 2023-October 2024) for recurrent cough, hemoptysis, and persistent eosinophilia (lasting 2 years). Initial leukocytosis normalized, while serial chest computed tomography (CT) revealed dynamic, migratory pulmonary lesions. Extensive investigations (X-pert/T-pert, repeated bronchoscopy with bronchoalveolar lavage fluid next-generation sequencing) were nondiagnostic, leading to successive misdiagnoses of viral pneumonia, mycoplasma infection, pulmonary mycosis, tuberculosis, and suspected malignancy.
During the hospitalization at the 924 Hospital, a bronchoscopy was performed. Bronchoalveolar lavage fluid high-throughput sequencing revealed the presence of Paragonimus westermani (sequence count: 6). Upon further inquiry, the patient reported a history of capturing and consuming raw freshwater crabs during a trip to Guizhou Province in June 2022, with a self-recorded video of this activity shared on social media. Subsequent diagnostic evaluation included multiple sputum examinations for parasitic eggs. Paragonimus eggs were identified during the third sputum concentration test, confirming a diagnosis of paragonimiasis.
Treatment consisted of oral praziquantel (0.2 g 3 times daily for 3 days), followed by a second cycle of anthelmintic therapy after a 1-week interval.
During the 4-month postdischarge period, the patient remained asymptomatic with complete resolution of both cough and hemoptysis. Serial laboratory monitoring demonstrated normalization of previously elevated eosinophil counts. Follow-up chest CT revealed significant radiographic improvement, including the complete disappearance of the irregular nodule in the left upper lobe and marked resolution of perilesional infiltrates surrounding the right pulmonary cavity.
In cases presenting with recurrent hemoptysis, persistent eosinophilia, and a history of raw crustacean consumption, accompanied by dynamic migratory pulmonary infiltrates on serial CT imaging, paragonimiasis should be strongly suspected despite initial diagnostic challenges.
A 45-year-old male was hospitalized 5 times across 4 tertiary centers in Guilin (January 2023-October 2024) for recurrent cough, hemoptysis, and persistent eosinophilia (lasting 2 years). Initial leukocytosis normalized, while serial chest computed tomography (CT) revealed dynamic, migratory pulmonary lesions. Extensive investigations (X-pert/T-pert, repeated bronchoscopy with bronchoalveolar lavage fluid next-generation sequencing) were nondiagnostic, leading to successive misdiagnoses of viral pneumonia, mycoplasma infection, pulmonary mycosis, tuberculosis, and suspected malignancy.
During the hospitalization at the 924 Hospital, a bronchoscopy was performed. Bronchoalveolar lavage fluid high-throughput sequencing revealed the presence of Paragonimus westermani (sequence count: 6). Upon further inquiry, the patient reported a history of capturing and consuming raw freshwater crabs during a trip to Guizhou Province in June 2022, with a self-recorded video of this activity shared on social media. Subsequent diagnostic evaluation included multiple sputum examinations for parasitic eggs. Paragonimus eggs were identified during the third sputum concentration test, confirming a diagnosis of paragonimiasis.
Treatment consisted of oral praziquantel (0.2 g 3 times daily for 3 days), followed by a second cycle of anthelmintic therapy after a 1-week interval.
During the 4-month postdischarge period, the patient remained asymptomatic with complete resolution of both cough and hemoptysis. Serial laboratory monitoring demonstrated normalization of previously elevated eosinophil counts. Follow-up chest CT revealed significant radiographic improvement, including the complete disappearance of the irregular nodule in the left upper lobe and marked resolution of perilesional infiltrates surrounding the right pulmonary cavity.
In cases presenting with recurrent hemoptysis, persistent eosinophilia, and a history of raw crustacean consumption, accompanied by dynamic migratory pulmonary infiltrates on serial CT imaging, paragonimiasis should be strongly suspected despite initial diagnostic challenges.