Ascaris lumbricoides in a young nose-A rare finding

Abstract

Background: Ascaris lumbricoides (A. lumbricoides) is one of the most common nematodes (roundworms) affecting humans more frequently. It generally infests the gastrointestinal tract. However, unusual sites may rarely be affected. Sinusitis is a quite common clinical complaint seen in ENT departments. However, A. lumbricoides as a cause of sinusitis is fairly uncommon. The rarity of the disease, vague clinical complaints, and nonspecific radiological findings may end in delayed diagnosis, leading to severe complications. Clinicians should keep in mind this rare diagnosis, especially in underdeveloped countries. Case presentation: A 3-year-old girl with a low socioeconomic background presented in the Department of ENT, Ch. Mohammad Akram Teaching & Research Hospital, Lahore, with a 15-day history of unilateral nasal blockage, and foul-smelling nasal discharge (blood stained on and off) from the right nostril. On examination, there was vague swelling on the right lateral wall of the nose that was firm to hard. The right maxillary sinus area and infra-orbital region were also vaguely enlarged. A radiographic examination of the head and neck revealed haziness in the right maxillary sinus; however, the rest of the paranasal sinuses were unremarkable. The right nasal cavity was filled with pale yellow/necrotic secretions. A thick pus-like collection was noted coming out from the maxillary ostium. Surgeons suspected some foreign bodies; however, no viable or dead cord-like structures were found during surgical manipulation. Discussion: Ascariasis is a worldwide common helminthic infection that is especially endemic in tropical/subtropical regions because of the suboptimal sanitary conditions. People are also unaware of their hygiene and how to dispose of their excreta, which is a major issue in the rural populations of developing countries. The major route of transmitting infection is ingesting embryonated eggs in the form of contaminated food/water or using raw vegetables/fruits without proper washing.