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CASE REPORT
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 39-41

Cerebral paragonimiasis mimicking tuberculoma: First case report in India


1 Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, 5th mile, Tadong, Gangtok, India
2 Naga Hospital Authority, Kohima, Nagaland, India
3 Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan

Correspondence Address:
T Shantikumar Singh
Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, 5th mile, Tadong, Gangtok-737 102, Sikkim
India
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DOI: 10.4103/2229-5070.72106

PMID: 23507623

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An 8-year-old male child of Tuensang District, Nagaland, India, attended Civil Hospital, Tuensang, complaining of cough, fever, headache, and inability to move right arm since one month. On clinical suspicion of tubercular meningitis, anti-tubercular therapy was initiated and the patient was referred to the Naga Hospital Authority. A brain computed tomography scan revealed an isodense area with surrounding edema on the left parietal lobe, which was diagnosed as tuberculoma and the anti-tubercular therapy was continued. As there was no sign of clinical improvement on completion of the three-month-ATD regimen, the patient was investigated for paragonimiasis. Laboratory investigations revealed peripheral blood eosinophilia, raised ESR, Paragonimus egg-positive sputum, and positive Enzyme-linked immunosorbent assay (ELISA) and ID tests for paragonimiasis. The Bacillus Calmette-Guιrin (BCG) test and Acid Fast Bacilli (AFB) sputum smears were negative. Chest roentgenogram showed no abnormal findings. A final diagnosis of pulmonary paragonimiasis associated with cerebral paragonimiasis was made. The patient responded to praziquantel therapy. Cerebral paragonimiasis is a serious extrapulmonary form of paragonimiasis, sometimes life-threatening, but curable with praziquantel. It should be included in the differential diagnosis of cerebral granulomatous and other space-occupying lesions.


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