This is a case report of intestinal eosinophilic granuloma caused by Ascaris ova and worm which is supposed to be rare in Korea. Case: A 23 year old healthy female reached Pusan Sanitation Hospital with complaints of high fever and abdominal pain on December 3 in 1966. Examination: Her temperature was 99.6 F. Pulse 80. Abdominal palpation showed muscle rigidity and tenderness. On the right side of the abdomen diagnosis due to ruptured appendix was made, and a laparotomy was performed the same day. Operation: Intestinal perforation by a Ascaris worm in the caecum about 7 cm from the ileo-caecal junction was also found. The worm was liquefied already. The intestine was edematous . Numerous rice sized nodules were seen on the intestine. The omentum was markdly inflammed and was adhered with a fist size mass. The mass and appendix were also resected in order to do a histological study. Pathology: Two kinds of tissues were examined : one a mesenteric mass, the other lymph node. Microscopically, it showed intensive and entirely necrotic tissue in which numerous parasitic ova were surrounded by granulomatous inflammatory cells with eosinophiles . The parasitic ova were degenerative and partialy necrotic although they had three layers of egg shell which are identified with Ascaris ova.
parasitology-helminth-nematoda ; Ascaris lumbricoides ; egg granuloma-case report ; eosinophile

Pulmonary paragonimiasis is one of the most important endemic parasitic disease in Korea. Although it is well known that Paragonimus westermani invades into the lung tissue eventually resulting respiratory failure, the pathogenesis of inducing lung lesions is not fully elucidated. It is still debatable on the nature of morphological component of 'cyst' which is known to be the most consistent change in lung paragonimiasis. For the purpose of clarification of morphological changes associated with pulmonary paragonimiasis, an experimental study was carried out by giving metacercariae of P. westermani to 10 dogs. These dogs were sacrificed 2 months and 6 months after infection respectively, and light microscopic and electron microscopic observations were made. Following conclusions were obtained. Paragonimus lung lesions could basically be classified into two categories, i.e., direct mechanical effects by the worms and eggs, and the changes secondary to the worm infection. The relative importance of these two appeared almost same. Adult worms of P. westermani reside inside the lumina of the dilated bronchi in great majority of the cases. Only exceptions were secondary abscess formation and subsequent scar where no epithelial lining was detected around the worms. In 6 months group almost all P. westermani worms were found inside the bronchial lumina. Obliterative endobronchiolitis was another prominent feature among changes that were not directly associated with worms or eggs. This finding was more prominent in the distal segments of the bronchial trees that harbor the Paragonimus worms. P. westermani eggs were found as isolated and aggregated fashions, provoking characteristic granulomatous inflammation. Some of the egg granulomas were seen in the areas apart from the locations where the worms were physically located. Ultrastructural observations of the cyst wall showed fair numbers of plasma cells and mast cells. Some of the cystlining epithelial cells showed increased deposit of glycogen granules, suggestive of early metabolic alteration of the respiratory epithelium.
parasitology-helminth-trematoda ; Paragonimus westermani ; paragonimiasis ; dog ; lung ; histology ; pathology ; egg granuloma ; plasma cell ; glycogen

Paragonimiasis is a parasitic disease caused by Paragnonimus species. The primary site of infection is the lung, and extrapulmonary involvement is also reported. When infected with Paragonimus westermani, which is the dominant species in Korea, the central nervous system is frequently involved along with the liver, intestine, peritoneal cavity, retroperitoneum, and abdominal wall. Ectopic paragonimiasis raises diagnostic challenge since it is uncommon and may be confused with malignancy or other inflammatory diseases. Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain. The patient developed abdominal pain 3 times for the previous 3 years and the computed tomography (CT) of the abdomen revealed fluid collection with wall enhancement. Recurrent diverticulitis was initially suspected and part of the ascending colon was resected. However, the specimen showed intact colon wall without evidence of diverticulitis and multiple parasite eggs and granulomas were found instead. The size of about 70 μm, the presence of an operculum and relatively thick egg shell suggested eggs of Paragonimus species. With appropriate exposure history and a positive antibody test, the definitive diagnosis was made as peritoneal paragonimiasis.
Abdomen ; Abdominal Abscess* ; Abdominal Pain ; Abdominal Wall ; Abscess ; Animals ; Central Nervous System ; Colon ; Colon, Ascending ; Diagnosis ; Diverticulitis* ; Egg Shell ; Eggs ; Granuloma ; Humans ; Intestines ; Korea ; Liver ; Lung ; Ovum ; Paragonimiasis* ; Paragonimus ; Paragonimus westermani ; Parasites ; Parasitic Diseases ; Peritoneal Cavity