Mediastinal mass as an unusual presentation of paragonimiasis in a child: a case report and review of diagnostic challenges

Paragonimiasis is a parasitic disease characterized by diverse clinical manifestations, among which pulmonary involvement is the most frequently observed. However, there are no documented cases of paragonimiasis presenting as a mediastinal mass. We report a case of paragonimiasis associated with such a presentation. A large mediastinal mass was identified in a 13-year-old child. Due to the limited efficacy of antibiotics and indeterminate diagnosis, thoracoscopic surgery was performed. Histopathological findings were consistent with paragonimiasis. The patient responded well to praziquantel treatment. This report reveals a novel, mediastinal presentation of paragonimiasis, a neglected disease, which posed a significant diagnostic dilemma due to its atypical features. Diagnostic thoracoscopy was essential for obtaining a definitive diagnosis, highlighting the importance of considering invasive diagnostic procedures when conventional approaches fail. The present case serves to remind clinicians to include paragonimiasis in the differential diagnosis of a mediastinal mass with chronic cough, especially in endemic areas or with a relevant dietary history.