Chinese Medical Journal

6 THE CHINESE MEDICAL JOURNAL

Pathological diagnosis. Paragonimiasis of brain; extensive necrosis of both frontal lobes, left temporal lobe, right parietal lobe; moderate hydrocephalus; old paragonimiasis of lungs; acute splenic tumor; slight fatty change of liver. Gause

of death: extensive damage to the brain due to paragonimiasis. (There was no evi-

dence of either pulmonary tuberculosis or tuberculous meningitis.)

Case 2. Patient Chin, a Korean boy, aged 12, was admitted to the Central People’s Hospital on October 26, 1954 on account of fever, headache, yomiting, and attacks of convulsions for one month and a half. He was previously treated in a hospital at Yingkou. His cerebrospinal fiuid showed: pressure 600 mm, cells 50-3,500 per cu mm, sugar 12.5 mg per cent, chloride 544.9 mg per cent, and pellicle formation twice. On October 18 tubercle bacilli were said to have been found in culture, and the patient was treated as a case of tuberculous meningitis with rimifon orally plus streptomycin intramuscularly and intrathecally but without any benefit. He was then sent to Peking for further investigation and treatment. The patient’s past history was not known as he was a war orphan.

Examination on admission showed the following findings: moderately developed, and moderately nourished. Mentally clear. Neck slightly stiff. Heart and lungs normal. Liver and spleen were not palpable. Neurological examination revealed ptosis of left upper eyelid. Kernig’s signs were positive on both sides. Eyeground examination showed slight edema of optic nerve head. Erythrocytes 3,700,000. Hemoglobin 12.5 gm. Leukocytes 8,800 with eosinophils 1-6 per cent. Urine and stool normal. Cerebrospinal fluid showed a pressure of 240 mm and 278 leukocytes of which 98 per cent were polymorphonuclear neutrophils, cerebrospinal fluid sugar was 37 mg per cent and chloride 684 mg per cent.

After admission the patient was treated with rimifon and streptomycin. On the fifth day of hospitalization, he suddenly developed high fever, lethargy, coma and incontinence of urine. Leukocytes in the blood were found increased to 27,000. The cerebrospinal fluid had a pressure of 330 mm, appeared cloudy, and contained 11,750 leukocytes per cu mm. Three days later the patient regained consciousness. By then the leukocytes in the spinal fluid were reduced to 175, but the spinal fluid sugar remained low at 25 mg per cent. Repeated examinations of the cerebrospinal fluid for tubercle bacilli including two animal inoculations were all negative. Roentgen examination showed no active lesions.

The patient after admission was subjected to paragonimus intradermal test and complement fixation tests of the serum and cerebrospinal fluid. The results were all positive. However, repeated examinations of the sputum, feces, and cerebrospinal fluid showed no parasite ova or tubercle bacilli. On November 12, the patient’s left eyeball was found to show some limitation of movement. In the meantime the muscular tone of the upper and lower limbs of the right side was reduced and rightsided Babinski’s sign and ankle clonus were demonstrated. Thereafter the patient often became lethargic and frequently vomited. The size of his pupils and their reaction to light varied from time to time. He was finally diagnosed as a case of paragonimiasis with cerebral involvement. He began to receive chloroquine treatment on December 4. Electrocardiogram done on December 27 revealed changes suggesting myocardial change. By December 31, 1954, the total dose of chloroquine given was 5.94 gm. The treatment was stopped as the patient showed signs of general muscular weakness. Exploratory craniectomy and a decompression operation to relieve intracranial pressure were considered, but the patient was too ill to be operated upon. His general condition became progressively worse and his visual power showed rapid deterioration. State of coma set in and eventually the patient died on January 12, 1955.

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