Enterobius vermicularis Salpingitis Seen in the Setting of Ectopic Pregnancy in a Malaysian Patient

Abstract

c We report a rare and unusual case of invasive Enterobius vermicularis infection in a fallopian tube. The patient was a 23-year-old Malaysian woman who presented with suprapubic pain and vaginal bleeding. A clinical diagnosis of ruptured right ovarian ectopic pregnancy was made. She underwent a laparotomy with a right salpingo-oophorectomy. Histopathological examination of the right fallopian tube showed eggs and adult remnants of E. vermicularis, and the results were confirmed using PCR and DNA sequencing. CASE REPORTO n 22 January 2014, a 23-year-old woman, who was in her second pregnancy and at 8 weeks of gestation, presented as an outpatient to the Emergency Department (ED) University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. She was referred by a private general practitioner after complaining of vaginal bleeding for 3 days with small amount of spotting and staining on her undergarment associated with suprapubic pain for a day. The pain was described as sharp pricking, nonradiating, and progressively increasing in severity. She did not have any vaginal discharge or fever. The result of a urine pregnancy test carried out at the private clinic was positive. When she missed her menses in December 2013, no test was done to confirm pregnancy. Bowel and urinary habits were normal. She did not have any medical illnesses or previous surgeries. No known allergies were noted. She had a full-term vaginal delivery in 2009. She attained menarche at the age of 12 years and has a regular menstrual cycle and is free of menorrhagia, dysmenorrhea, dyspareunia, and postcoital bleeding. She is on a natural method of contraception, and a cervical smear test had never been done before.On physical examination, she appeared pale, with early signs of hypovolemia as evidenced by tachycardia with pulse rate of 110 to 120 beats per min and blood pressure ranging between 90 to 94 and 60 to 70 mm Hg. Fluid resuscitation was immediately started in the emergency department. Her vital signs were monitored continuously. Cardiorespiratory examination revealed no abnormalities. Her abdomen was mildly distended. There was presence of tenderness at the lower abdomen with guarding. Neither an abdominal scar nor organomegaly was noted. Vaginal examination revealed a normal vulvovaginal surface, and her cervix was tubular. The cervical excitation result was positive, with fullness in the Pouch of Douglas. Adnexal tenderness was elicited bilaterally.Transabdominal pelvic sonography revealed an empty uterus with a right irregular adnexal mass measuring 9 mm and a moderate level of free fluid that was 50 mm deep. Blood investigations revealed anemia, with hemoglobin at 6.7 g/dl and with a normal white blood cell count and platelet level. Preoperative diagnosis of a ruptured right ectopic pregnancy with hypovolemia was made. Informed consent for a laparotomy was provided by both the patient and her husband after they were counseled with respect to the working diagnosis and the intended procedure. She underwent laparotomy with right salp...

Gynecological and obstetrical aspects of Enterobius vermicularis infection

“…Supporting evidence for this includes the exclusive presence of female worms and ova in reproductive tract lesions [2]. A case has been reported in the scientific literature when the parasite ascending in the fallopian tube caused salpingitis with extrauterine gravidity and led to acute abdominal catastrophe with bleeding to the abdominal cavity [9]. Thereby, enterobiasis should be treated with antihelminthic agents after its confirmation.…”

The neglected role of Enterobius vermicularis in appendicitis: A systematic review and meta-analysis

“…However, complete life cycle of the helminth, from egg to adult worm, usually takes 2 to 4 weeks [17]. Although E. vermicularis infection commonly presents with perianal pruritus [18], it has also been reported to be associated with chronic abdominal pain, urinary tract infection, salpingitis, eosinophilic ileocolitis and pelvic abscess [19][20][21][22]. Couple of possible hypotheses explained the correlation between E. vermicularis and appendicitis of which mostly suggested ectopic migration of the parasite [23,24].…”

Acute suppurative appendicitis associated with Enterobius vermicularis: an incidental finding or a causative agent? A case report

“…Also, aberrant migrations leading to extraintestinal findings of E. vermicularis have been reported, in the liver [ 12 ], bladder [ 13 ], lungs [ 14 ], kidney [ 15 ] or in the female genital tract [ 16 , 17 ]. Thus, this parasite can have a wide range of pathogenicity, implying that pathologists should be familiar to its histological aspects for correct diagnosis.…”