Two cases of cutaneous paragonimiasis initially presenting with respiratory symptoms

Paragonimiasis is an infectious disease caused by Paragonimus westermani and usually manifests as pulmonary disease. Cutaneous paragonimiasis is very rare, and the correct diagnosis is delayed in most cases. Here we report two cases of cutaneous paragonimiasis with pulmonary lesion in Korea. The first case presented as a chest wall mass and pleural effusion with no lung lesions on chest radiographs or computed tomography. Biopsied materials showed fibrosis and eosinophilic inflammation. A definite diagnosis was made by identifying eggs of P. westermani in the sputum and specific antibody in the serum by ELISA. The second case manifested as multiple lung lesions and two subcutaneous nodules in the left lateral thigh and left flank area. Excision biopsy of the subcutaneous nodules identified adult worm of P. westermani with surrounding eosinophilic granulomas.