719
2020년 제 71차 대한내과학회 추계학술대회
￭S-676 ￭ Ascites and Plerual and Pericardial Effusions in Parasitic Infections: A Case Report
건국대학교병원 내과 김정우, 박소영
Pathological accumulation of fluids in the pleural, peritoneal, and pericardial space occurs in various conditions. Malignancies, infections, systemic inflammations, or autoimmune diseases are the most common causes. Human parasitic infections usually present with eosinophilia and can be accompanied by pleural effusion or ascites. Herein, we report the case of a patient who showed improved pleural, pericardial effusion and ascites after treatment with anthelmintics. A 55-year-old man visited the clinic with dyspnea, chest pain, and mild fever that was persisting for 10 days. The computed tomography (CT) scan confirmed left side pleural effusion and paratracheal lymph node hyperplasia, suggesting tuberculosis (TB) pleurisy (Figure 1A). Initial laboratory test showed increased WBC count (11,000/μL) with eosinophilia (8.5%) and CRP level (5.06 mg/dL). He was discharged from the hospital start with TB medications (HREZ). It revealed yellowish exudative pleural effusion with an increased eosinophil count (43%), proof of tuberculosis was not obtained (Table 1). A week later, he returned to the outpatient clinic with worsening symptoms; CT scan revealed increased bilateral pleural effusion, accompanied by pericardial effusion (Figure 1B). Therefore, he was readmitted and treated with antibiotics.
Bronchoscopy and gastroscopy did not yield any significant results. His abdominal pain gradually worsened and abdominal CT scan was performed (Figure 1C); TB peritonitis was suspected due to ascites and omental cake. Laboratory test showed: WBC, 9,820/μL;
eosinophilia, 14.5 %; AST/ALT, 69/167 IU/L; CRP, 13.18 mg/dL; ANA test was negative. Parasitic examination was performed and the result was positive for clonorchis sinensis and toxocariasis. Administration of praziquantel, albendazole and corticosteroid improved his symptoms and effusion. Pleural effusion or eosinophilic ascites can be caused by parasites; however, they are rarely accompanied by pericardial effusion. Although there is a limitation that parasite has not been clearly demonstrated (only serological evaluation), it is important that all clinical manifestations improved after the administration of anthelmintics.
