An 8-year-old male child of Tuensang District, Nagaland, India, attended Civil Hospital, Tuensang, complaining of
cough,
fever,
headache, and inability to move right arm since one month. On clinical suspicion of
tubercular meningitis, anti-tubercular
therapy was initiated and the patient was referred to the Naga Hospital Authority. A brain computed tomography scan revealed an isodense area with surrounding
edema on the left parietal lobe, which was diagnosed as
tuberculoma and the anti-tubercular
therapy was continued. As there was no sign of clinical improvement on completion of the three-month-ATD regimen, the patient was investigated for
paragonimiasis. Laboratory investigations revealed peripheral blood
eosinophilia, raised ESR, Paragonimus egg-positive sputum, and positive
Enzyme-linked
immunosorbent assay (ELISA) and ID tests for
paragonimiasis. The Bacillus Calmette-Guérin (BCG) test and
Acid Fast Bacilli (AFB) sputum smears were negative. Chest roentgenogram showed no abnormal findings. A final diagnosis of pulmonary
paragonimiasis associated with cerebral
paragonimiasis was made. The patient responded to
praziquantel therapy. Cerebral
paragonimiasis is a serious extrapulmonary form of
paragonimiasis, sometimes life-threatening, but curable with
praziquantel. It should be included in the differential diagnosis of cerebral granulomatous and other space-occupying lesions.