Spontaneous Pneumothorax Secondary to Pulmonary Paragonimiasis: A Case Report Highlighting Diagnostic Delay in Eastern Nepal

Paragonimiasis, or oriental lung fluke, a zoonotic disease acquired by consuming raw or undercooked crustaceans such as crabs or snails, can mimic tuberculosis in endemic regions. There is a wide range of clinical symptoms depending on the parasite location, from non-specific symptoms like diarrhoea, abdominal pain, rash, and fever to pleuropulmonary symptoms like cough, haemoptysis, chest pain, and dyspnoea. Pneumothorax is the rare clinical picture. We present a case of a 48-year-old male non-smoker with a persistent cough for 3 months and who was treated for acute eosinophilic pneumonia initially at another centre. He then presented with symptoms of spontaneous pneumothorax at our centre and was treated with a chest tube. Revisiting the history, raw snail consumption was noted. Microscopic examination of a wet mount bronchoalveolar lavage (BAL) confirmed the diagnosis of <i>Paragonimus westermani</i>, and praziquantel was started; he improved significantly within 48 h.