Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2019; 7(1): 95-101
Published online Jan 6, 2019. doi: 10.12998/wjcc.v7.i1.95
Authenticity of pulmonary Lophomonas blattarum infection: A case report
Shuang-Shuang Meng, Zhi-Feng Dai, Hui-Chao Wang, Yu-Xia Li, Dan-Dan Wei, Rui-Lin Yang, Xu-Hong Lin
Shuang-Shuang Meng, Zhi-Feng Dai, Yu-Xia Li, Dan-Dan Wei, Rui-Lin Yang, Xu-Hong Lin, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, Henan Province, China
Hui-Chao Wang, Department of Nephrology, First Affiliated Hospital of Henan University, Kaifeng 475000, Henan Province, China
Author contributions: Meng SS and Lin XH designed the report; Meng SS, Dai ZF, Wang HC, Li YX, and Yang RL collected the patient’s clinical data; Wei DD and Lin XH took pictures of light and electron microscopy; Meng SS, Dai ZF, and Lin XH wrote the paper.
Supported by the National Natural Science Foundation of China, No. 81500430 and No. U1304802; the Science and Technology Planning Project of Henan Province, No. 182102310567, No. 182102310544, and No. 182102310566; the Henan Medical Science and Technology Tackling Project, No. 201702136; and Key Project of Science and Technology Research of Education Department of Henan Province, No. 17A320019.
Informed consent statement: Consent was obtained from relatives of the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts.
CARE Checklist (2016) statement: The guidelines of the “CARE Checklist - 2016” have been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xu-Hong Lin, MD, Associate Professor, Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital Affiliated to Henan University, 115 Ximen Street, Kaifeng 475000, Henan Province, China.
Telephone: +86-371-23906758 Fax: +86-371-23906058
Received: September 5, 2018
Peer-review started: September 6, 2018
First decision: October 19, 2018
Revised: October 28, 2018
Accepted: December 7, 2018
Article in press: December 8, 2018
Published online: January 6, 2019

Pulmonary protozoal infections are rare. A 28-year-old woman was admitted to hospital with chief complains of cough, sputum, and dyspnea. The clinical laboratory tests for blood revealed an increased eosinophil percentage of 31.3% and significantly elevated total IgE. The chest computed tomography scan revealed that bilateral bronchial walls were thickening, accompanied with patchy spots scattered throughout bilateral lungs. A suspected multiflagellated protozoan was observed under a light microscope. But some different features were observed by electron microscopy, such as the orientation of flagella and nucleus. Besides, both bronchoalveolar lavage fluid and bronchoscopic brush smears underwent Gram staining and Pap staining, which revealed that numerous respiratory ciliated cells were scattered or accumulated in the sample. Finally, she was diagnosed with eosinophil pneumonia. Metronidazole, bronchodilators, and mucolytics were taken for 5 d and symptoms and pulmonary ventilation function improved. We herein report a case of chronic eosinophilic pneumonia, which was misdiagnosed as multiflagellated protozoan infection, and it is suggested that reliable diagnosis approaches are necessary, rather than clinical symptoms and morphological features.

Keywords: Multiflagellated protozoan, Respiratory disease, Parasitic infection, Case report

Core tip: Lophomonas blattarum is a rare cause of respiratory infection. Nonspecific clinical symptoms and signs confuse diagnosis. On the other hand, it is easily misdiagnosed probably because of a set of common morphological features between multiflagellated protozoan and ciliated epithelial cells. Therefore, we reviewed the difficulties encountered during the diagnosis in order to improve the understanding of this disease and reduce the incidence of incorrect and missed diagnoses.