Hymenolepis nana infestation is commonly diagnosed in school-aged children and very rarely reported in adults patients in Saudi Arabia. We encountered an adult Saudi patient with a H. nana infection. The patient presented with a chronic history of vague abdominal pain and diarrhoea. He had negative laboratory examinations as well as a negative report on stool sample analysis. After misdiagnosis of his symptoms as Irritable Bowel Syndrome and failed treatment for Irritable Bowel Syndrome, he was readmitted to hospital. After thorough but negative physical, systemic and laboratory examinations, and stool sample microscopy, the patient underwent careful ileo-colonoscopy. He was found to have a H. nana infestation and after treatment with praziquantel, his symptoms were resolved. Our study supports the view that colonoscopy, with careful examination of intestinal mucosa, is a useful diagnostic approach for patients with parasitic infections and negative stool examinations.
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