抗旋毛虫抗体陽性を示し、クマ肉生食により感染したと思われるウェステルマン肺吸虫症

Abstract

We treated a patient with paragonimiasis who showed a distinct immunopositivity for Trichinella spiralis. A 28-year-old male entered a local hospital in October 2003 because of acute renal failure, anemia, and multiple bone fractures. Intensive treatment was successfully performed, during which bilateral pleural effusion appeared transiently, with continuing eosinophilia and muscle weakness in the left upper arm. To examine the persistent eosinophilia and muscle weakness, the patient visited our hospital in April 2005. Neurological examinations and histological studies revealed muscle atrophy that was limited to the left upper arm, which was considered due to a local factor such as injection or injury. A hematological examination confirmed increased eosinophils (WBC 13300/μ1; eosinophils 44%). Further, chest X-P and CT images revealed a recurrence of bilateral pleural effusion and a nodular lesion in the upper lobe of the left lung. Since a strong immunopositivity against Paragonimus westermanii was demonstrated, we made a diagnosis of paragonimiasis. The patient was effectively treated with praziquantel and the clinical course was uneventful. In several interviews, the patient reported that he had not eaten crab; however, we discovered that he had eaten bear meat more than 5 times at a restaurant operated by his friend and ingested slices of raw bear meat on at least one occasion. A serological examination revealed a strong seropositivity for Trichinella spiralis. We considered that the Paragonimus westermanii infection in the present case was mediated by the ingestion of raw bear meat.