結核性腹膜炎・腹膜播種様の所見を呈した肺吸虫症の1例

A case of paragonimiasis mimicking tuberculous peritonitis or peritoneal dissemination

肺吸虫症は食品由来寄生虫症の代表例であり，モクズガニやサワガニ，イノシシ肉，シカ肉などを加熱不十分な状態で摂取することにより感染する。主として肺に病変をきたすが，その他にも腹部臓器や皮膚，中枢神経系など様々な部位に病変が出現する。中でも大網や腸間膜，腹膜などに病変を認めた場合には，結核性腹膜炎や悪性腫瘍の腹膜播種との鑑別が難しいことがある。今回我々が経験した肺吸虫症の症例に関して，若干の文献的考察を加えて報告する。

A middle-aged woman presented to our hospital with complaints of diarrhea and fever. Abdominal CT scan showed increased adipose tissue density in the omentum and mesentery. Numerous granular and small nodular shadows were also seen, which suggested tuberculous peritonitis or peritoneal dissemination. Chest CT scan showed right pneumothorax and pleural effusion, and blood test showed increased eosinophils. All things considered, paragonimiasis was suspected, and the diagnosis was confirmed by antibody test. Paragonimiasis is mainly in the lungs, but can sometimes resemble peritonitis or peritoneal dissemination on imaging. Knowledge of the imaging findings of abdominal lesions due to paragonimiasis can aid early diagnosis and avoidance of unnecessary biopsies.