title: A Case of Delayed Diagnosis of Pulmonary Paragonimiasis due to Improvement after Anti-tuberculosis Therapy.
abstract: Here, we report a case of pulmonary paragonimiasis that was improved with initial anti-tuberculosis (TB) therapy but confused with reactivated pulmonary TB. A 53-year-old Chinese female presented with a persistent productive cough with foul smelling phlegm and blood streaked sputum. Radiologic findings showed subpleural cavitary consolidation in the right upper lobe (RUL). Bronchoscopic and cytological examination showed no remarkable medical feature. She was diagnosed with smear-negative TB, and her radiologic findings improved after receiving a 6-month anti-TB therapy. The chest CT scans, however, obtained at 4 months after completion of anti-TB therapy showed a newly developed subpleural consolidation in the RUL. She refused pathologic confirmation and was re-treated with anti-TB medication. Nevertheless, her chest CT scans revealed newly developed cavitary nodules at 5 months after re-treatment. She underwent thoracoscopic wedge resection; the pathological examination reported that granuloma caused by Paragonimus westermani. Paragonimiasis should also be considered in patients assessed with smear-negative pulmonary TB.
authors.affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
authors.forename: Suhyeon
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
authors.forename: Yeonsil
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
authors.forename: Jinyoung
authors.initials: J
authors.lastname: An
authors.affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
authors.forename: Jeongmin
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul Medical Center, Seoul, Korea.
authors.forename: Jin-Sung
authors.initials: JS
authors.lastname: Son
authors.affiliation: Department of Radiology, Seoul Medical Center, Seoul, Korea.
authors.forename: Young Kyung
authors.initials: YK
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
authors.forename: Sookhee
authors.initials: S
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
authors.forename: Hyeok
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
authors.forename: Suhyun
authors.initials: S
authors.lastname: Kim
keywords: Paragonimus westermani; Tuberculosis