# Case Report: Simultaneous Paragonimus skrjabini infection in twin girls with spontaneous emergence of a juvenile worm from the eyelid of the elder sister

## TL;DR

Two twin girls were diagnosed with a rare Paragonimus infection after eating raw crabs, with one showing a worm emerging from her eyelid.

## Contribution

Demonstrates the use of mNGS and ELISA in diagnosing rare Paragonimus skrjabini infections in twin patients.

## Key findings

- Both twin sisters showed evidence of Paragonimus skrjabini infection confirmed by ELISA and mNGS.
- The elder sister had a juvenile worm spontaneously emerge from her eyelid and showed cerebral symptoms.
- Praziquantel treatment successfully resolved the infection in both sisters.

## Abstract

We reported a rare case of paragonimiasis occurring in twin sisters who had eaten raw crabs 7 months ago. The elder sister complained of eyelid swelling and migratory lumps, while the younger sister was asymptomatic. Laboratory tests showed eosinophilia and elevated levels of inflammatory indicators in the two sisters. The brain MRI of the elder twin showed hyperintensity in the frontal lobe, suggesting cerebral hemorrhage. The chest CT image of the twins showed pulmonary involvement. Enzyme-linked immunosorbent assay (ELISA) for serum antibody test and metagenomic next-generation sequencing (mNGS) of subcutaneous tissue from the eyelid—obtained via sterile puncture aspiration under local anesthesia—confirmed Paragonimus skrjabini infection. After praziquantel treatment, both of the sisters recovered. This study aims to enhance clinical awareness and highlight the application of advanced molecular diagnostic technologies for identifying rare parasitic infections.