Advocate Lutheran General Hospital Park Ridge, IL, United States
Sufyan AbdulMujeeb, DO1, Essam Quraishi, MD2, Suraiyya Omar, 3 1Advocate Lutheran General Hospital, Park Ridge, IL; 2GI and Liver Consultants, Irvine, CA; 3Other, Park Ridge, IL
Introduction: Once proven, eradicating helminthic infection can be extremely facile. Identifying them, however, can sometimes be arduous. Peripheral eosinophilia and presence of ova and parasites in stool are easily obtained and most commonly encountered in patients with helminthic infection. Occasionally, these typical clues may not be present and capsule endoscopy may provide a definitive diagnosis in such scenarios. We present a case of helminthic infection in a young female that was diagnosed by capsule endoscopy in the absence of other diagnostic clues.
Case Description/Methods: A 23-year-old female presented for evaluation of abdominal discomfort, constipation, and hematochezia for a few weeks duration. She had a recent travel history to Cambodia and was concerned that she may have seen fragments of moving worms in her stool. Her labs were significant for WBC 6.6k/mcL (nl 5-10k/mcL), hemoglobin 10.5 g/dL (nl 13 to 17 g/dL), MCV 61 fl (NL 80-100 fl), and eosinophil 0.5k/mcL (nl 0-0.5k/mcL). Multiple tests for ova and parasites returned negative for worm infestation. Colonoscopy performed to evaluate anemia and hematochezia revealed a small foreign body, pathological evaluation of which suggested a worm fragment. Repeat stool ova and parasite testing continued to be unremarkable. Upon evaluation with capsule endoscopy, a large number of segmented nematodes were noted extending from the first part of the jejunum. She was treated with praziquantel with subsequent passage of worms the following day. She reported complete resolution of symptoms. A repeat capsule endoscopy performed three weeks later was negative for helminths.
Discussion: Helminthic infection is more common in the developing world and is typically spread by consumption of undercooked food. Symptoms may include abdominal pain, fatigue due to concomitant anemia and malabsorption, and sometimes bowel obstruction. Asymptomatic individuals may be diagnosed when unexplained peripheral eosinophilia is noted. Subsequent stool testing for ova and parasites typically prove helminth infestation. Occasionally, diagnosis can be difficult to make in the absence of elevated eosinophils and negative stool testing. EGD and colonoscopy may also fail to reveal the diagnosis as helminths typically harbor the small intestine. In such scenarios, capsule endoscopy may prove to be beneficial in confirming the diagnosis.
Figure: Different segments of small bowel showing the presence of a tapeworm on capsule endoscopy
Sufyan AbdulMujeeb indicated no relevant financial relationships.
Essam Quraishi indicated no relevant financial relationships.
Suraiyya Omar indicated no relevant financial relationships.
Sufyan AbdulMujeeb, DO1, Essam Quraishi, MD2, Suraiyya Omar, 3. P1986 - Helminth Infection Diagnosed by Capsule Endoscopy in the Absence of Peripheral Eosinophilia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.