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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 182 -186. doi: 10.3877/cma.j.issn.1674-1358.2024.03.009

病例报告

肺吸虫病误诊为结核性胸腔积液一例
成丹1, 王骁2, 李洪波2, 任涛2, 王建坤2,†()   
  1. 1. 442000　十堰市，太和医院（湖北医药学院附属太和医院）输血医学科
    2. 442000　十堰市，太和医院（湖北医药学院附属太和医院）呼吸与危重症医学科
  • 收稿日期:2023-10-12 出版日期:2024-06-15
  • 通信作者: 王建坤
  • 基金资助:
    2022年湖北省自然科学基金项目(No. 2022CFB028)

A case of lung fluke disease misdiagnosed as tuberculous pleural effusion

Dan Cheng1, Xiao Wang2, Hongbo Li2, Tao Ren2, Jiankun Wang1,†()   

  1. 1. Department of Blood Transfusion Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
    2. Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
  • Received:2023-10-12 Published:2024-06-15
  • Corresponding author: Jiankun Wang
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引用本文：

成丹, 王骁, 李洪波, 任涛, 王建坤. 肺吸虫病误诊为结核性胸腔积液一例[J]. 中华实验和临床感染病杂志(电子版), 2024, 18(03): 182-186.

Dan Cheng, Xiao Wang, Hongbo Li, Tao Ren, Jiankun Wang. A case of lung fluke disease misdiagnosed as tuberculous pleural effusion[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(03): 182-186.

目的

探讨以胸腔积液为主要临床表现的肺吸虫病（LFD）的临床特征及实用诊断方法。

方法

报告1例就诊于十堰市太和医院的49岁男性患者，以"双侧下胸部间断钝痛、呼吸困难1年"为主诉，影像学表现为左侧胸腔积液的LFD患者的临床误诊经过，并分析其误诊原因。

结果

本例以胸腔积液为主要表现的LFD患者被误诊为结核性胸腔积液长达1年余，后经内科胸腔镜发现其胸膜组织中存在嗜酸性粒细胞，以及外周血嗜酸性粒细胞绝对值高达2.64 × 109/L；结合患者肺吸虫抗原皮试（IDTPA）及肺吸虫血清抗体酶联免疫吸附试验（ELISA）阳性结果，确诊为LFD。后患者院外遵医嘱口服吡喹酮（25 mg·kg-1·次-1、3次/d）4个疗程，达到临床治愈。

结论

外周血及胸膜活检组织中嗜酸性粒细胞升高对LFD的诊断和疗效分析有重要意义。详细询问个人史，及时进行IDTPA是LFD早发现、早诊断的关键。

关键词: 胸腔积液, 肺吸虫病, 嗜酸性粒细胞, 肺吸虫特异性抗原皮试, 吡喹酮
Objective

To investigate the clinical features and practical diagnostic method of lung fluke disease (LFD) that presented with pleural effusion as the main clinical manifestation.

Methods

The clinical diagnosis and treatment of a 49-year-old male patient with LFD who complained of intermittent dull pain and dyspnea in bilateral lower chest for one year with radiological findings of left pleural effusion and admitted to Taihe Hospital of Shiyan City, and the causes of misdiagnosis were analyzed.

Results

This LFD patient with pleural effusion was misdiagnosed as tuberculous pleural effusion for longer than one year. There was abnormal elevation of eosinophils in pleural tissue, and the absolute count of eosinophils in peripheral blood was as high as 2.64 × 109/L. Finally, combined with the positive results of intradermal tests for Paragonimus-specific antigens (IDTPA) and enzyme-linked immunosorbent assay (ELISA) of serum antibodies to Paragonimus, the diagnosis of lung fluke disease was confirmed. The patient received praziquantel (25 mg·kg-1· times-1, 3 times a day) for 4 courses outside the hospital according to the doctor’s advice, and demonstrated clinical improvement.

Conclusions

Elevated eosinophils in peripheral blood and pleural biopsies are important for the diagnosis and therapeutic effect analysis of LFD. Detailed inquiry of personal history and timely IDTPA are the keys to early diagnosis of LFD.

Key words: Pleural effusion, Pneumostomiasis, Eosinophils, Intradermal tests for Paragonimus-specific antigen, Praziquantel
表1 患者外周血实验室指标
外周血 数值 百分比（%）
WBC 10.52 × 109/L —
NE 5.84 × 109/L 55.5
Ly 1.29 × 109/L 12.3
MO 0.75 × 109/L 7.1
EOS 2.64 × 109/L 25.1
BA 0 0.0
RBC 3.66 × 1012/L —
Hb 118 g/L —
PLT 181 × 109/L —
TB-Ab 阳性 —
PPD 阴性 —
ESR 30 mm/h —
表2 患者胸水实验室检查
胸水 结果
外观 红色、浑浊
Rivalta 阳性
有核细胞（× 109/L） 2.20
多核细胞（%） 90.00
单核细胞（%） 10.00
Hs-CRP（mg/L） 11.52
总蛋白（g/L） 53.55
葡萄糖（mmol/L） 6.72
总胆固醇（mmol/L） 3.22
乳酸脱氢酶（U/L） 519.20
腺苷脱氨酶（U/L） 21.40
淀粉酶（U/L） 12.70
癌胚抗原（μg/L） 1.00
图1 患者胸腔镜、组织病理学及肺吸虫特异性抗原皮内试验注：A：壁层胸膜附着有黄白色脓苔；B：苏木精-伊红染色可见嗜酸性粒细胞浸润（400 ×）；C：患者手臂皮下注射肺吸虫特异性抗原呈阳性反应
图2 患者治疗前后胸部CT注：A：胸部CT显示左侧少量胸腔积液；B：胸部CT示双肺正常，胸腔积液消失
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