# Mediastinal mass as an unusual presentation of paragonimiasis in a child: a case report and review of diagnostic challenges

## TL;DR

A child presented with a mediastinal mass caused by paragonimiasis, a rare and unusual manifestation of this parasitic disease.

## Contribution

This is the first documented case of paragonimiasis presenting as a mediastinal mass.

## Key findings

- A 13-year-old child with a mediastinal mass was diagnosed with paragonimiasis after thoracoscopic surgery.
- Praziquantel treatment was effective in resolving the condition.
- Diagnostic thoracoscopy was crucial for confirming the atypical diagnosis.

## Abstract

Paragonimiasis is a parasitic disease characterized by diverse clinical manifestations, among which pulmonary involvement is the most frequently observed. However, there are no documented cases of paragonimiasis presenting as a mediastinal mass. We report a case of paragonimiasis associated with such a presentation.

A large mediastinal mass was identified in a 13-year-old child. Due to the limited efficacy of antibiotics and indeterminate diagnosis, thoracoscopic surgery was performed. Histopathological findings were consistent with paragonimiasis. The patient responded well to praziquantel treatment.

This report reveals a novel, mediastinal presentation of paragonimiasis, a neglected disease, which posed a significant diagnostic dilemma due to its atypical features. Diagnostic thoracoscopy was essential for obtaining a definitive diagnosis, highlighting the importance of considering invasive diagnostic procedures when conventional approaches fail. The present case serves to remind clinicians to include paragonimiasis in the differential diagnosis of a mediastinal mass with chronic cough, especially in endemic areas or with a relevant dietary history.