Pulmonary paragonimiasis is a parasitic infection which is acquired through ingestion of raw or undercooked freshwater crustaceans containing metacercariae, often mimicking pulmonary tuberculosis in endemic regions and causing diagnostic confusion. We present a 34-year-old male with history of non-productive cough, weight loss, episodic fever, pruritus, and maculopapular rash for three months with a history of raw freshwater crab ingestion for perceived health benefits. Chest imaging showed right sided pleural effusion with consolidation. Laboratory investigations revealed peripheral eosinophilia and elevated inflammatory markers. No organisms or ova were detected, despite microbiological testing of sputum, pleural fluid, and bronchoalveolar lavage. Provisional diagnosis of paragonimiasis was made on basis of eosinophilia, dietary history, and clinical findings. Empirical albendazole followed by praziquantel led to rapid symptom resolution and decreased eosinophil counts. This case highlights the diagnostic challenges in tuberculosis-endemic, resource-limited settings and the importance of dietary history to prevent misdiagnosis and unnecessary anti-tubercular therapy.
Singh et al. (Sat,) studied this question.