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

BACKGROUND: 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. CASE 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. CONCLUSIONS: 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.