2011;29:371C373. 2 Pathologic findings of the peritoneal nodule. (A) Granuloma made up of numerous parasite eggs (arrow head). A part of the nodule is usually shown enlarged in (B). The characteristics of the parasite eggs are shown in (C) and (D). Bar=1 mm in (A), 100 m in (B) and 50 m in (C) and (D). Conversation Here, we KRAS G12C inhibitor 13 offered a case of peritoneal paragonimiasis who suffered from recurrent abdominal pain. Since the thick-walled cavitary lesions were adjacent to the cecum on abdominal CT, recurrent diverticulitis and intra-abdominal abscess were in the beginning considered. Only after the surgery, paragonimiasis was diagnosed based on the pathologic findings and subsequent serology. When the abdominal pain is usually localized to the right lower quadrant, usual differential diagnosis includes acute appendicitis, diverticulitis, colitis, and inflammatory bowel diseases. Some of these diseases can cause recurrent episodes. For example, underlying colonic diverticulosis could result in repeated diverticulitis and unresolved vascular problem can cause recurrent ischemic colitis. In our case, the in the beginning recognized lesions on CT were peritoneal fluid dispersion with excess fat infiltration. They developed into thick-walled cavitary lesions made up of dirty fluid or debris over 27 months and remained in the comparable position. The chronic nature of the lesions and an absence of diverticulosis in colonoscopy suggested some kinds of chronic peritoneal inflammatory diseases, including parasite infections. The definitive diagnosis was made as peritoneal paragonimiasis after a surgery. Paragonimiasis is usually a parasitic disease caused by species. Humans are usually infected when they consume inadequately cooked crabs or crayfish which contain the encysted metacercariae of species. In Korea, is the most common etiology, and soybean sauce marinated freshwater crabs are well-known as the source of human paragonimiasis. When a metacercaria contained in the crab is Itga2b usually swallowed, it excysts in the small intestine, penetrates the intestinal wall to the peritoneal cavity, and techniques through the diaphragm and pleura into the lung. The larva makes a cyst-like capsule in the lung and matures inside the cavity. Clinical symptoms of pulmonary paragonimiasis occur when the cyst capsule ruptures into the bronchioles. The parasite eggs are discharged through the airway when the infected patients cough. Even though lung is the most common site of contamination, other organs such as the central nervous system, liver, intestine, peritoneal cavity, retroperitoneum, and abdominal wall are also known to be involved [2C7]. In many cases, mass-like lesions or abscess were found in the involved organs. Malignancy is usually a concern, so surgical resection is usually performed to treat the abscess and to exclude the malignancy. On surgical removal, worms or eggs of species could be found. When PubMed and KoreaMed were searched with terms of ectopic paragonimiasis, 10 articles of either English or Korean language were found after the 12 months 2010 [6,8C16]. These cases included 5 cases of subcutaneous contamination, 5 of intra-abdominal contamination, 2 of central nervous system contamination, and 1 case of mediastinal cavity contamination. All the cases underwent either radiological tissue biopsy or surgery, and the final diagnoses were made from pathological examinations exposing the parasite or eggs. The definitive diagnosis of ectopic paragonimiasis can be made when worms or eggs of characteristic shape are found on a surgical specimen. When the specimen could not reveal the typical characteristics of worm or eggs, molecular approaches, such as KRAS G12C inhibitor 13 PCR can be helpful [17]. Some cases are diagnosed with exposure history, radiological findings, and immunological test. Commonly, ELISA is used to measure antibodies to species. However, a positive ELISA test does not always imply that active contamination is present, since it took 4 to 18 months for the antibody level to decrease to a normal level [18]. Praziquantel 25 mg/kg 3 times for 2C3 days are usually used to treat ectopic paragonimiasis, including cerebral paragonimiasis [19]. Surgery is usually performed when the lesions KRAS G12C inhibitor 13 are relatively superficial and easy to remove or when the dead worm accompanied complications [17]. In addition to species, the metacercariae of migrate to the peritoneal cavity to reach the liver and bile duct, the usual site of contamination. Occasionally, the metacercaria is usually entrapped in the peritoneum, grows to be an adult, and produces abscess [20,21]. Larvae of species and the plerocercoid of species (=sparganum) can also penetrate the wall of the gastrointestinal tract and could be found in the peritoneal cavity [22,23]. These parasitic infections are known to produce varying degrees of mesenteric infiltrations, peritoneal nodules,.
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