Magnetic susceptibility-weighted imaging mapped the migratory route of a paragonimus in brain

A 53-year-old man with a recent history of left temporal lobe hemorrhage presented with weakness of left upper limb for 4 days. Paragonimus eggs were detected in patient's sputum. Work up revealed paragonimiasis, a lung fluke worm infection endemic to East Africa, West Africa and South America which rarely involves in brain. Characteristic tunnel sign was visualized on brain MRI. Notably, susceptibility-weighted imaging revealed a migratory pattern of the parasite from the left temporal lobe to the right parietal lobe and resultant patchy hemorrhage. Treatment with praziquantel resulted in favorable outcome without residual deficits.