만성 복통과 발진을 주소로 내원한 6세 여아에서진단된 폐흡충증 1예
A Case of Pulmonary Paragonimiasis with Chronic Abdominal Pain and Erythematous Rash in a 6-year-old Girl
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
기생충 감염은 소아 인구에게서 드물기 때문에 진단이 어려울 수 있다. 환아는 6개월 동안 간헐적인 상복부 통증과 양손과 양측 팔 모두에 발생한 홍반성 발진을 동반한 늑막 삼출을 주소로 내원하였다. 환아는 검사상 혈청 호산구증가와 현저한 삼출성, 호산구성 흉막삼출액이 확인되었다. 동시에 폐렴 미코플라스마에 대한 높은 항체가 때문에 항생제 치료를 받았으나 흉막삼출은 호전되지 않았다. 환아의 분변에서 시행한 기생충 알의 검사상 음성이었으나 혈청 및 흉막삼출액의 기생충 특이 항원에 대한 면역효소측정법에서 폐흡충 특이 IgG에 대해 양성을 보였다. Praziquantel의치료 후 호흡기 증상, 흉수 및피부 증상이 호전되었다. 이에 만성 복통과 홍반성 발진을 주소로 내원한 소아 환자에서 폐흡충에 의한흉막삼출액을 진단 및 치료하였기에 보고하는 바이다.
Abstract
Pleural paragonimiasis is uncommon in the pediatric population and therefore can be challenging to diagnose. This is a case of a 6-year-old girl with pleural effusion who had been having intermittent persistent epigastric pain and erythematous rash on the face, hands, and arms for 6 months. Exudative pleural effusion with prominent eosinophils and serum eosinophilia were observed. As patient showed high immunoglobulin M (IgM) titers against Mycoplasma pneumoniae , she was treated with antibiotics; however, the pleural effusion did not improve during hospitalization. Despite showing negative stool ova and cyst results, patient's serum and pleural effusion were positive for Paragonimus westermani -specific IgGs on enzyme-linked immunosorbent assay. Respiratory symptoms, pleural effusion, and skin symptoms improved after praziquantel treatment.
참고문헌 (18)
- 송진호, "Recent Incidence of Paragonimus westermani Metacercariae in Freshwater Crayfish, Cambaroides similis, from Two Enzootic Sites in Jeollanam-do, Korea", Parasites, Hosts and Diseases, 55(3), pp.347~350 (2017), 대한기생충학ㆍ열대의학회
- Kim TI, "Inactivation of Paragonimus westermani metacercariae in soy sauce-marinated and frozen freshwater crabs", Parasitol Res, 116, pp.1003~1006 (2017)[DOI]
- Pham Ngoc Doanh, "Paragonimus and Paragonimiasis in Vietnam: an Update", Parasites, Hosts and Diseases, 51(6), pp.621~627 (2013), 대한기생충학ㆍ열대의학회
- 황기은, "Pleural fluid characteristics of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis", The Korean Journal of Internal Medicine, 30(1), pp.56~61 (2015), 대한내과학회[DOI]
- Ferreiro L, "Concordant and discordant exudates and their effect on the accuracy of light's criteria to diagnose exudative pleural effusions", Am J Med Sci, 352, pp.549~556 (2016)[DOI]
- Diny NL, "Eosinophils in autoimmune diseases", Front Immunol, 8, pp.484~ (2017)[DOI]
- Freeman AF, "Hyper-IgE syndromes and the lung", Clin Chest Med, 37, pp.557~567 (2016)[DOI]
- Oba Y, "The prevalence and diagnostic significance of eosinophilic pleural effusions: a meta-analysis and systematic review", Respiration, 83, pp.198~208 (2012)[DOI]
- Xia Y, "Cerebral paragonimiasis: a retrospective analysis of 27 cases", J Neurosurg Pediatr, 15, pp.101~106 (2015)[DOI]
- Ashitani J, "Paragonimiasis westermani with multifocal lesions in lungs and skin", Intern Med, 39, pp.433~436 (2000)[DOI]
- Sim YS, "Paragonimus westermani found in the tip of a little finger", Intern Med, 49, pp.1645~1648 (2010)[DOI]
- Shafritz AB, "Acute and chronic paronychia of the hand", J Am Acad Orthop Surg, 22, pp.165~174 (2014)[DOI]
- Azkur D, "Clinical and etiologic evaluation of the children with chronic urticaria", Allergy Asthma Proc, 37, pp.450~457 (2016)[DOI]
- Chai JY, "Paragonimiasis", Handb Clin Neurol, 114, pp.283~296 (2013)
- 이선화, "ELISA를 이용한 간흡충, 폐흡충, 유구낭미충 및 스파르가눔에 대한 특이항체 검사양성 예에 대한 고찰", Annals of Laboratory Medicine, 23(2), pp.126~131 (2003), 대한진단검사의학회
- 이미경, "Seroprevalence of Tissue Invading Parasitic Infections Diagnosed by ELISA in Korea", Journal of Korean Medical Science, 25(9), pp.1272~1276 (2010), 대한의학회
- Pewpan M. Intapan, "Evaluation of IgG4 Subclass Antibody Detection by Peptide-Based ELISA for the Diagnosis of Human Paragonimiasis Heterotrema", Parasites, Hosts and Diseases, 51(6), pp.763~766 (2013), 대한기생충학ㆍ열대의학회
- Hu Y, "Pleuropulmonary paragonimiasis with migrated lesions cured by multiple therapies", Indian J Pathol Microbiol, 59, pp.56~58 (2016)