Pulmonary Paragonimiasis Presenting as Pneumothorax, Hemoptysis, and Severe Eosinophilia: A Case Report.

Paragonimiasis is a foodborne zoonosis transmitted mostly by the consumption of inadequately cooked crabs and crayfish harboring Paragonimus metacercariae. We present the case of a 38-year-old male with a history of crab ingestion who developed severe eosinophilia, transaminitis, and serositis. Initial presentation included fever, epigastric pain, weight loss, and pleural effusion. He was managed empirically with albendazole and corticosteroids along with other supportive measures. Two months later, he re-presented with hemoptysis and hypoxemia. HRCT showed multiple cavitary pulmonary lesions, pleural nodules, and left-sided pneumothorax. Sputum wet mount demonstrated Paragonimus species ova, confirming pulmonary paragonimiasis. The patient was managed with intercostal tube drainage, tranexamic acid nebulization, and praziquantel with clinical improvement. This case highlights the importance of considering paragonimiasis in patients, even with pneumothorax, when the patient has hemoptysis and eosinophilia in the background of ingestion of raw or undercooked crustaceans in endemic regions.