A clinical mimicry of malignancies in patients diagnosed with paragonimiasis

Abstract Paragonimiasis commonly mimics tuberculosis (TB) and malignancies. Its clinical mimicry with TB has been buttressed in reviews documented in the literature, but regarding malignancies, review studies are sparse. We identified 20 cases of paragonimiasis published between 1996 and July 2024 clinically misdiagnosed as malignancies mainly due to suggestive radiological findings including increased fluorodeoxyglucose uptake ( n = 8, 40%), nodules ( n = 8, 40%), masses ( n = 6, 30%), cavitations ( n = 4, 20%), opacities ( n = 4, 20%) and enlarged lymph nodes ( n = 3, 15%). Of the 20, seven were from Korea (35%), five were from China (25%), three from Japan (15%) and one each from Taiwan (5%), Vietnam (5%), Thailand (5%), India (5%) and the USA (5%). Predominant presenting complaints were cough ( n = 8, 40%) and haemoptysis ( n = 4. 20%). Paragonimiasis was misdiagnosed predominantly as lung cancers ( n = 10, 50%), hepatic malignancy ( n = 3, 15%) and adrenal gland tumour ( n = 2, 10%). Diagnosis of paragonimiasis was majorly by histopathology ( n = 15, 75%) and serology ( n = 8, 40%). Treatment outcomes were stated in 16 cases and were all favourable. Driving awareness of paragonimiasis, especially in endemic regions, should be prioritised to improve cognizance of cases, prompt diagnosis and initiation of antihelminthic therapy and avert unnecessary surgical investigations. Unnecessary resection of tissues for histopathological diagnosis can be minimised by utilising other diagnostic methods such as serology and microscopy.