A 48-year-old male patient was admitted to the hospital for paroxysmal distention and pain in the middle and upper abdomen for 1 week. One week before admission, the patient experienced sudden distension and pain in the middle and upper abdomen. The specific abdominal pain site was not constant. The attack was paroxysmal, and the degree was not severe. Each attack lasted approximately 2-3 min. There was spontaneous remission without radiation pain in the shoulder and back. Changes in body position did not relieve the pain. Moreover, the pain aggravated after eating. The patient felt slightly relieved after defecation but was exhausted. He used to wake up at night because of pain. The pain was not related to fatigue and satiety. There were no symptoms of paroxysmal aggravation. Acid reflux was noted. Before the onset of the disease, the patient had consumed crab food and drank white wine. The patient had previously developed hepatitis A. He had a history of smoking and drinking for some decades, with consumption of 100 ml white wine daily.
Physical examination at admission revealed the following findings: clear mind, no apparent dry and wet rales in both lungs, uniform heart rhythm, no murmur, soft abdomen, tenderness in the right lower abdomen, no rebound tenderness, active bowel sounds, and no swelling of both lower limbs.
After admission, the relevant examination of the digestive system was performed. Abdominal ultrasound showed a rough surface of the gallbladder wall and multiple cholesterol crystals in the gallbladder. Gastroscopy revealed chronic superficial gastritis and duodenitis. Colonoscopy showed swelling and bulge of mucosa of the descending colon. Blood routine examination showed that the white blood cell count was 11.7 x 10 9/L, and the eosinophil ratio was 14.3%. Considering the patient's abdominal pain, symptomatic treatment such as esomeprazole magnesium enteric-coated tablets for protecting the stomach and pinaverium bromide tablets for relieving spasms were given. Four days later, the patient developed cough, expectorating white phlegm, and mild asthma. In the physical examination, a few wet rales could be heard in both lower lungs. The white blood cell and the levels of CRP and PCT increased. Combined with chest radiographs, lung infection was considered, and cefodizime combined with azithromycin was given for treatment. Chest CT showed the following findings: (1) Multiple patch dense shadow and nodular shadow in both lungs, with a high possibility of inflammation. It was recommended to re-examine after anti-inflammatory treatment, by excluding tumors; (2) Partial atelectasis in the lower lobe of both lungs; (3) Multiple slightly larger lymph nodes in the mediastinum and hilum of both lungs; and (4) local thickening of the pleura on both sides. After transfer to the respiratory department, the patient was given piperacillin-tazobactam combined with levofloxacin for anti-infection treatment. C-reactive protein and procalcitonin showed a downward trend. Re-examination of the blood routine showed that T lymphocytes increased while B lymphocytes and NK cells decreased. Bronchoscopy showed that all bronchial lumens were unobstructed, and the mucosa was smooth. No new organisms were found, and no special findings were found in the related pathogen examination. TBLB showed chronic inflammation and interstitial mucus degeneration (bronchial mucosa of right BII, right BIX, and left BIII). The pathological examination with colonoscopy showed that chronic inflammation in the descending colon accompanied with submucosal inflammatory granulation tissue formation and necrosis. The results of the delivery examination showed that paragonimiasis was positive, and Cryptococcus latex qualitative test was negative. The definite diagnosis was paragonimiasis.