A rare case report: Intestinal and hepatic ascariasis

Ascaris lumbricoides is amongst the common helminth disease worldwide. Ascariasis is more prevalent in developing countries especially in communities with poor socioeconomic conditions. In endemic areas, ascariasis is more common during the first 2 to 3 years of age. Despite a high incidence of intestinal ascariasis, the hepatic ascariasis with adult worm is extremely rare. We report a case of a 22-month-old girl lived in Manokwari, West Papua, Indonesia who presented with abdominal pain, difficulty to pass the stool and distended abdomen. She previously had diarrhea and vomiting containing worms in the last 2 days after taking the anthelmintic (albendazole), which is routinely given by the community health center in Manokwari every 6 months. On the physical examination, she was febrile and pale. On fecal examination, adult worms of Ascaris lumbricoides were found. Ultrasonography (USG) is a good diagnostic tool in visualizing worms in the gut lumen and hepatobiliary system. The patient’s USG revealed multiple tubular hypoechoic structures, well-defined, with varying hyperechoic edges; accompanied by serpiginous structures with a hypoechoic halo in the right and left lobe of the liver. The patient was diagnosed with intestinal and hepatic ascariasis. Because there is very limited data of hepatic ascariasis, the patient was treated with standard treatment for ascariasis such as albendazole 200 mg (single dose) and pyrantel pamoate 100 mg for 3 days. She also got antibiotics and symptomatic therapies for 12 days. She went home in good condition.