title: Pleural fluid characteristics of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis.
abstract: OBJECTIVE
  Pleuropulmonary paragonimiasis produces no specific symptoms or radiologic findings, allowing for the possibility of misdiagnosis. We evaluated the specific clinical and pleural fluid features of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis.
  
  
  METHODS
  We retrospectively analyzed the clinical and radiologic characteristics of 20 patients diagnosed with pleuropulmonary paragonimiasis between 2001 and 2011.
  
  
  RESULTS
  In total, 17 patients presented with respiratory symptoms, including dyspnea (30%), hemoptysis (20%), cough (20%), and pleuritic chest pain (15%). Chest radiographs revealed intrapulmonary parenchymal lesions, including air-space consolidation (30%), nodular opacities (20%), cystic lesions (15%), ground-glass opacities (10%), and pneumothorax (5%). A pleural fluid examination revealed eosinophilia, low glucose levels, and high lactate dehydrogenase (LDH) levels in 87%, 76%, and 88% of the patients, respectively. These traits helped to distinguish pleuropulmonary paragonimiasis from other pleural diseases such as parapneumonic effusion, malignancy, and pleural tuberculosis.
  
  
  CONCLUSIONS
  Pleuropulmonary paragonimiasis is often initially misdiagnosed as other pleural diseases. Therefore, it is important to establish the correct diagnosis. In patients with unexplained pleural effusion living in paragonimiasis-endemic areas, pleural fluid obtained by thoracentesis should be examined to distinguish pleuropulmonary paragonimiasis. When marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid, physicians could consider a diagnosis of pleuropulmonary paragonimiasis.
authors.affiliation: Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Ki-Eun
authors.initials: KE
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Hyo-Yeop
authors.initials: HY
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Jae-Wan
authors.initials: JW
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Su-Jin
authors.initials: SJ
authors.lastname: Oh
authors.affiliation: Department of Radiology, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Kwon-Ha
authors.initials: KH
authors.lastname: Yoon
authors.affiliation: Department of Laboratory Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Do-Sim
authors.initials: DS
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Eun-Taik
authors.initials: ET
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.
authors.forename: Hak-Ryul
authors.initials: HR
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D015415:Biomarkers / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D004802:Eosinophilia / Q000175:diagnosis / Q000469:parasitology; D005260:Female; D005947:Glucose / Q000032:analysis; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000032:analysis; D008174:Lung Diseases, Parasitic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D019152:Paracentesis; D010237:Paragonimiasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000469:parasitology; D048492:Paragonimus westermani / Q000302:isolation & purification*; D010996:Pleural Effusion / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000469:parasitology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014396:Tuberculosis, Pleural / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007770:L-Lactate Dehydrogenase; D005947:Glucose
keywords: Pleuropulmonary paragonimiasis; Tuberculosis, pleural