Ectopic peritoneal paragonimiasis mimicking tuberculous peritonitis: A care report

INTRODUCTION

Infestation with

species is the diagnosis of paragonimiasis. Although

(

) infested the lungs most commonly, in rare cases, they can be found only in other organs without the involvement of the lungs. In the case of Involvement of the lungs, it is diagnosed by the identification of

eggs in stool or sputum examination. The diagnosis of ectopic infection can be made when worms or eggs of characteristic shape are found on tissue. Enzymelinked immunosorbent assay (ELISA) for antibodies or molecular identification by polymerase chain reaction (PCR) can be helpful for diagnosis.

The nervous system and gastrointestinal system are other areas that can be infested other than the lungs. Humans are infected with

in form of metacercariae by eating raw freshwater crustaceans. The metacercariae exocyst in the duodenum, and then pass through the intestinal wall, peritoneal cavity, diaphragm, and pleural cavity to the lung. Due to this migratory route, ectopic infections can occur such as peritoneum. Intraperitoneal paragonimiasis without lung involvement may be misdiagnosed as tuberculous peritonitis. However, in most cases, it can be differentiated through eosinophilia, a positive stool test, and typical medical history of crustacean consumption.

He has smoked 1 pack a day for 30 years. He has consumed approximately 57 g of alcohol per week.

CASE PRESENTATION

Chief complaints

A 57-year-old man was admitted for the evaluation of recurrent lower abdominal pain that had persisted for 2 mo.

History of present illness

He received intermittent medications for abdominal pain in a private clinic for 2 mo. Two days before the visit, he underwent abdominal computed tomography (CT) at another hospital and was transferred for the differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis.

The white blood cell count was 4960/mm

(reference, 4000-10000/mm

), the proportion of eosinophils was 4.4% (reference, 1%-5%), and there were no abnormal findings in the laboratory findings. The Creactive protein level was 1.7 mg/L, which was within the normal range (reference, 0-5 mg/L). The carcinoembryonic antigen was 1.43 ng/mL (reference, 0-3.4 ng/mL) and carbohydrate antigen 19-9 was 13.98 U/mL (reference, 0-34 U/mL). The interferon-gamma release assay test result was negative, and the results of tuberculosis tests, including sputum stain, culture, and PCR, were all negative. The stool examination result was negative.

History of past illness

He received a diagnosis of a 5-mm-sized rectal neuroendocrine tumor at another hospital one year prior and underwent endoscopic mucosal resection.

Personal and family history

Here, we present a case of intraperitoneal paragonimiasis mimicking tuberculous peritonitis with no involvement of lungs, no eosinophilia, and a negative stool test.

Physical examination

He was given a total of 1800 mg (25 mg/kg) of praziquantel in 3 divided doses per day for 3 d and he recovered from all symptoms. He was discharged on the 10

day of hospitalization.

從現有的研究來看，作為現代漢語中十分常見而又復雜的“讓”字還鮮有研究。因此，該文在加的夫語法的指導下對現代漢語“讓”字進行多維度的分析。

傳統的人行天橋采用混凝土結構形式，而鋼結構的強度高，適用于大跨度以及大載荷的橋梁工程施工中。另外，鋼結構還具有良好的可塑性，能夠有效成熟靜力荷載狀態的抗變形能力，不容易受到超載的影響而發生斷裂。

Laboratory examinations

在汾河流域節水灌溉發展水平綜合評價指標體系中包括5個定性指標和9個定量指標，其中定性指標包括政策法規、政府支持、宣傳教育、公眾參與、技術推廣體系建立。定性指標量化方法如下：

Imaging examinations

Diffuse peritoneal infiltration and subtle wall thickening of the right colon with multiple reactive lymph nodes were found on abdominal CT (Figure 1). Meanwhile, no lung lesions were observed on chest CT, and no enlarged lymph nodes were observed. On colonoscopy, a scar caused by a previous mucosal resection was observed 2 cm above the anal valve, and there was no evidence of recurrence. Only atrophic gastritis was found on esophagogastroduodenoscopy.

Further diagnostic work-up

Exploratory laparoscopy was performed to determine the cause of the peritoneal lesions. Intraoperative findings showed multiple small whitish nodules and an abscess in the peritoneum (Figure 2). Peritoneal nodules 1-2 mm in size were observed throughout the abdominal cavity, and excisional biopsy was performed. During right pelvic wall dissection, abscess pockets with pus surrounded by the omentum were observed. Omentectomy was performed for some of the omentum. An incidental appendectomy was also performed.

Based on the pathological reports, numerous eggs of

were confirmed in all specimens of the excisional biopsy, omentectomy, and appendectomy (Figure 3).

This case was intraperitoneal paragonimiasis, which was difficult to differentiate from tuberculous peritonitis and peritoneal carcinomatosis. This is because he denied crustacean consumption during his first history-taking, the stool test result was negative, and there was no eosinophilia or lung involvement.

During retrograde history-taking, it was reported that he often consumed food consisting of raw freshwater crab several months prior.

FINAL DIAGNOSIS

The final diagnosis was intraperitoneal paragonimiasis without other organ involvement.

TREATMENT

Physical examination revealed mild tenderness in the right lower quadrant. The patient’s temperature was 36.4 °C, heart rate was 72 bpm, respiratory rate was 18 breaths per minute, blood pressure was 125/85 mmHg

OUTCOME AND FOLLOW-UP

Recurrence was not observed in the subsequent 2 years.

（2）地質災害可預報、可監測，這也就強調積極開展生態化地質災害防治工作的必要性與重要性。當前，隨著現代科學技術的不斷發展，人類在地質災害防范上，已取得了諸多的科技成果，在很大程度上提高了地質災害的防治能力。但是，地質災害防治關乎一個國家、地區的穩定發展，關系到人民百姓的生產財產安全和生存環境，地質災害防治工作是一項長期而艱巨的工作，需要逐步強化并建立完善的地質災害防范工作體制，強化地質災害預測及應急處理能力，最大程度地降低地質災害對社會發展、人民群眾財產安全的威脅和環境的影響。

DISCUSSION

A postoperative ELISA revealed positivity for antibodies against

in the serum. There were no specific findings on brain CT.

There have been previous reports of intraperitoneal paragonimiasis, but with differentiating points, such as intrathoracic lesions[1], intraperitoneal calcifications[2,3], and eosinophilia[4], whereas no signs of paragonimiasis, such as calcification or eosinophilia, were observed in the present case. In a Korean case report[5], similar to the present case, a 57-year-old woman presented with paragonimiasis mimicking omental seeding nodules and transverse colonic wall thickening without eosinophilia and lung involvement, and an intraoperative frozen biopsy was performed for diagnosis. She was treated with praziquantel for 2 d.

In addition, despite the denial of the possibility of parasitic infestation at the time of history-taking in the present case, he recalled that he had consumed soy sauce crab several months before being diagnosed with paragonimiasis through surgery. Soy sauce crab is a dish that commonly causes paragonimiasis in Korea.

For the differential diagnosis of tuberculous peritonitis mimicking peritoneal infiltration without eosinophilia and other involvement, especially with a negative latent tuberculosis test result, serologic ELISAs for antibodies against

can be helpful. If serologic antibody tests for parasitic infestations had been performed before diagnostic laparoscopy, unnecessary surgery may have been avoided through repeated medical history taking. He was treated with praziquantel for 3 d after receiving the diagnosis of intraperitoneal paragonimiasis, and no recurrence was observed for 2 years thereafter.

用紅茶對海螺肉進行浸泡，在其他條件一定的情況下，考察紅茶濃度、浸泡時間、浸泡溫度對海螺肉腥味的影響。各因素試驗范圍為紅茶濃度0.4，0.6，0.8，1.0，1.2 g/L；浸泡時間10，20，30，40，50 min；浸泡溫度25，30，35，40，45 ℃。采用Box-Behnken 法以紅茶濃度(A)、浸泡時間(B)、浸泡溫度(C)為自變量，綜合感官分值(Y)為響應值進行3因素3水平的中心組合試驗，見表1。

記者在程立生“受賄清單”中發現，程立生與這15人長期保持聯系，長期為他們承攬項目，長期接受吃請和金錢賄絡。

CONCLUSION

Even with normal stool tests and eosinophil counts on complete blood count, preoperative serologic antibody tests against

may be helpful in diagnosing intraperitoneal paragonimiasis without other organ involvement in patients who require diagnostic laparoscopy for the differential diagnosis of tuberculous peritonitis and peritoneal carcinomatosis.

FOOTNOTES

Lee CM contributed to the collection and organization of data; Choi JW wrote the draft; Kim SJ, Hah SI, and Kwak JY, Cho HC, Ha CY, Jung WT, and Lee OJ revised the manuscript for important intellectual content; All authors have read and approved the final manuscript.

A patient was not required to give informed consent for the study because this is a study that analyzed data retrospectively at a specific point that had already been completed in the treatment process. In the entire research process, including clinical data collection, analysis, and manuscript preparation, the possibility of infringing on the human rights of the subject patient is judged to be minimal, and the confidentiality of the subject patient’s personal information has been thoroughly maintained. Therefore, it is considered that the procedure for obtaining written consent from the subject patient can be omitted.

No conflicts exist for any author.

The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

South Korea

應用SPSS 22.0統計學軟件進行數據分析，計量資料以表示，組間比較采用獨立樣本t檢驗，計數資料采用χ2檢驗，P<0.05表示差異有統計學意義。

Jung Woo Choi 0000-0002-4133-8791; Chang Min Lee 0000-0001-5587-2023; Seong Je Kim 0000-0001-5956-276X; Se In Hah 0000-0001-9953-8908; Ji Yoon Kwak 0000-0002-6812-6625; Hyun Chin Cho 0000-0001-7750-474X;Chang Yoon Ha 0000-0002-7693-6601; Woon Tae Jung 0000-0002-1464-5462; Ok Jae Lee 0000-0002-4016-4443.

對于扦插繁殖，采用一定生長激素處理插穗能夠輔助其生根發芽。生根粉能通過強化、調控植物內源激素的含量和重要酶的活性，促進生物大分子的合成，誘導植物不定根或不定芽的形成，調節植物代謝強度等作用。IAA(吲哚-3-乙酸)是一種植物體內普遍存在的內源生長素，其基本作用在于不僅能促進生長，還具有抑制生長和器官建成的作用。NAA(萘乙酸)具有促進細胞分裂與擴大，誘導形成不定根，增加坐果，防止落果，改變雌、雄花比率等作用。研究表明，生根粉處理的小花清風藤扦插繁殖成活率較高，其中，以生根粉150 mg/L的成活率最高，可作為小花清風藤扦插生產過程中插穗處理的生長激素。

Chang KL

A

本文采用中國各大手機制造公司2016-2017年的年度數據，對研發投入和營銷投入如何影響公司主營業務利潤進行實證檢驗。結果發現: 當年的研發費用和營銷費用對其當年的主營業務利潤均沒有顯著影響；前1年研發投入對當年的主營業務利潤有顯著的積極影響，前1年的營銷費用對當年的主營業務利潤則有顯著的消極影響。

Chang KL

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