The holy fluke - an unusual scenario of lung paragonimiasis

Like many other foodborne parasites, lung fluke (Paragonimus species) was considered extinct and is now reemerging, especially in Eastern Asia, Africa, and South America. It commonly affects people consuming crabs and crayfish in their diet. This family of seafood and mollusks is considered an intermediate host for the parasite. Humans and other mammals, such as tigers and pigs incidentally consuming crustaceans, are the definitive hosts. Here, we present a case of pulmonary paragonimiasis in a strict vegetarian who developed the infestation, the possible cause being frequent baths in the holy river Ganges, a common practice amongst Hindus. Another interesting aspect of this case is that the patient presented with signs and symptoms mimicking tuberculosis, which is also endemic in the region. Presenting symptoms of hemoptysis, generalized malaise, and a normal chest X-ray were misleading, while Flexible Bronchoscopy (FB) with Bronchoalveolar Lavage (BAL) confirmed the diagnosis. The patient made a full recovery with appropriate treatment.