Misdiagnosis of pulmonary paragonimiasis as tuberculosis: A case report.

연구 요약

Misdiagnosis of pulmonary paragonimiasis as tuberculosis: A case report.

Medicine 학술지에 발표된 이 연구는 Li R, Liu X, Song G 외 연구팀이 수행하였습니다.

이 연구는 'Misdiagnosis of pulmonary paragonimiasis as tuberculosis: A case report.'에 대한 과학적 분석을 제공합니다.

핵심 내용

RATIONALE: Pulmonary paragonimiasis and pulmonary tuberculosis exhibit overlapping clinical and imaging manifestations, resulting in frequent misdiagnosis in endemic areas. This case underscores the value of metagenomic next-generation sequencing (mNGS) in correcting such misdiagnoses and emphasizes the importance of managing drug-drug interactions between antituberculosis agents and praziquantel. PATIENT CONCERNS: An 18-year-old female from Yunnan, a paragonimiasis-endemic region, presented with recurrent cough, expectoration, and hemoptysis for 4 years. She was initially diagnosed with pulmonary tuberculosis based on a positive tuberculin pure protein derivative test and chest computed tomography findings but failed to respond to antituberculosis therapy. DIAGNOSES: Pulmonary paragonimiasis (initially misdiagnosed as pulmonary tuberculosis). INTERVENTIONS: In-hospital tuberculosis-related tests (GeneXpert MTB/RIF, sputum/bronchoalveolar lavage fluid culture, bronchoscopic biopsy) were negative. Bronchoalveolar lavage fluid mNGS identified 87 Paragonimus sequences, and Paragonimus antibody enzyme-linked immunosorbent assay was positive. A history of raw crab ingestion was confirmed. Antituberculosis treatment was discontinued for 4 weeks (due to drug interaction), followed by oral praziquantel (1.2 g, 3 times daily for 3 consecutive days). OUTCOMES: Hemoptysis resolved within 15 days of treatment initiation, and peripheral blood parameters returned to normal ranges. Chest computed tomography at 2 months posttreatment showed marked reduction in lesion size, and complete resolution of pulmonary cavities was observed at the 6-month follow-up, with no recurrence of symptoms. LESSONS: For chronic respiratory symptoms unresponsive to antituberculosis treatment in endemic regions, proactive inquiry of raw freshwater crustacean consumption history and combined use of serology/mNGS can improve diagnostic accuracy. A 4-week washout period after rifampicin discontinuation is critical before praziquantel administration.

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