ascaris

7/21/2019 Ascaris http://slidepdf.com/reader/full/ascaris-56d99f41ae5bd 1/1 The new england journal of medicine n engl j med 373;15 nejm.org October 8, 2015 e 18 Images in Clinical Medicine A 30-year-old woman who was otherwise healthy presented to the emergency department with worsening pain in the right upper quadrant that had developed approximately 10 days earlier. She reported that the pain was not radiating but that it was exacerbated by deep inspiration. A review of systems was notable for an irritating cough, decreased appetite, and generalized fatigue. The patient reported that she did not have any other symptoms. On physical examination, she was found to have diminished breath sounds over the right lung field and abdominal pain on palpation of the right upper quadrant. The results of routine blood testing were unremarkable. Axial images of the thorax (shown) and abdomen on a computed tomographic scan showed a distended stom- ach with worms present; three hypodense nodular formations of the liver were also evident, a finding consistent with biliary cysts. The patient was treated with mebendazole and passed Ascaris lumbricoides worms in her stool. On evaluation 2 months later, she was asymptomatic, and her stool tested negative for parasites. Patients infected with ascaris are often asymptomatic. When patients do present for evaluation, common signs of infection include cough, fever, abdominal dis- comfort, and eosinophilia. However, as was the case with this patient, the presen- tation may not follow this pattern, and the diagnosis may be made with imaging. DOI: 10.1056/NEJMicm1413793 Copyright © 2015 Massachusetts Medical Society. Joana Sotto Mayor, M.D. Sofia Esperança, M.D. Hospital de Braga Braga, Portugal [email protected] Lindsey R. Baden, M.D., Editor Gastric Ascaris Infection The New England Journal of Medicine Downloaded from nejm.org by silvia noemi isabel amadeo on December 15, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.

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7/21/2019 Ascaris

http://slidepdf.com/reader/full/ascaris-56d99f41ae5bd 1/1

T he n e w e n g l a n d j o u r n a l o f medicine

n engl j med 373;15 nejm.org October 8, 2015e18

Images in Clinical Medicine

30-year-old woman who was otherwise healthy presented to

the emergency department with worsening pain in the right upper quad-

rant that had developed approximately 10 days earlier. She reported that thepain was not radiating but that it was exacerbated by deep inspiration. A review of

systems was notable for an irritating cough, decreased appetite, and generalized

fatigue. The patient reported that she did not have any other symptoms. On

physical examination, she was found to have diminished breath sounds over the

right lung field and abdominal pain on palpation of the right upper quadrant. The

results of routine blood testing were unremarkable. Axial images of the thorax

(shown) and abdomen on a computed tomographic scan showed a distended stom-

ach with worms present; three hypodense nodular formations of the liver were

also evident, a finding consistent with biliary cysts. The patient was treated with

mebendazole and passed Ascaris lumbricoides worms in her stool. On evaluation 2

months later, she was asymptomatic, and her stool tested negative for parasites.

Patients infected with ascaris are often asymptomatic. When patients do presentfor evaluation, common signs of infection include cough, fever, abdominal dis-

comfort, and eosinophilia. However, as was the case with this patient, the presen-

tation may not follow this pattern, and the diagnosis may be made with imaging.

DOI: 10.1056/NEJMicm1413793

Joana Sotto Mayor, M.D.Sofia Esperança, M.D.

Hospital de BragaBraga, [email protected]

Lindsey R. Baden, M.D., Editor

Gastric Ascaris Infection

The New England Journal of Medicine

Downloaded from nejm.org by silvia noemi isabel amadeo on December 15, 2015. For personal use only. No other uses without permission.

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