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Riedel J, Halm U, Prause C, Vollrath F, Friedrich N, Weidel A, Wendt S, Zachäus M. [Multilocular hepatic masses due to Enterobius vermicularis]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:490-493. [PMID: 36732426 DOI: 10.1007/s00108-023-01479-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 05/11/2023]
Abstract
Infestation with Enterobius vermicularis involving extraintestinal manifestation is rare. In a 50-year-old man with lower abdominal pain, computed tomography led to a suspected diagnosis of sigmoid carcinoma with liver metastasis. After ruling out colon cancer by endoscopy, laparoscopic resection of one suspected tumor nodule in the liver was performed. Histopathological examination revealed parasitic granulomas containing pinworms. Hematogenous migration was postulated in the setting of phlebitis with thrombosis of the inferior mesenteric vein.
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Affiliation(s)
- J Riedel
- Klinik für Gastroenterologie, Hepatologie, Hämatologie, Onkologie, Palliativmedizin, Helios Park-Klinikum Leipzig, Strümpellstr. 41, 04289, Leipzig, Deutschland
| | - U Halm
- Klinik für Gastroenterologie, Hepatologie, Hämatologie, Onkologie, Palliativmedizin, Helios Park-Klinikum Leipzig, Strümpellstr. 41, 04289, Leipzig, Deutschland
| | - C Prause
- Klinik für Gastroenterologie, Hepatologie, Hämatologie, Onkologie, Palliativmedizin, Helios Park-Klinikum Leipzig, Strümpellstr. 41, 04289, Leipzig, Deutschland
| | - F Vollrath
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Helios Park-Klinikum Leipzig, Leipzig, Deutschland
| | - N Friedrich
- Abteilung für diagnostische Radiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - A Weidel
- Institut für Pathologie am Elsapark, Leipzig, Deutschland
| | - S Wendt
- Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - M Zachäus
- Klinik für Gastroenterologie, Hepatologie, Hämatologie, Onkologie, Palliativmedizin, Helios Park-Klinikum Leipzig, Strümpellstr. 41, 04289, Leipzig, Deutschland.
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Zakharia K, Klair JS, Murali AR. Unusual Etiology for Transaminitis. Dig Dis 2019; 37:518-520. [PMID: 31203293 DOI: 10.1159/000499874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/24/2019] [Indexed: 02/02/2023]
Abstract
An infection with Enterobius vermicularis (pinworm) commonly affects the gastrointestinal (GI) tract. The ectopic localization of an enterobius infectious is rare, especially in the liver. We report the case of a 37-year-old man who presented to the gastroenterology clinic with abdominal pain and was found to have elevated transaminases. Workup for acute/chronic liver disease was unrevealing. He underwent endoscopic evaluation showing a live pinworm in the colon. He was treated with albendazole with improvement in GI symptoms and resolution of his transaminitis. There are scarce reports in the literature describing pathognomonic, clinical, imaging, and laboratory findings for pinworm infection. Here, we attempt to review the literature for hepatic involvement with an enterobius infection and discuss the findings via this case.
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Affiliation(s)
- Kais Zakharia
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jagpal Singh Klair
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA,
| | - Arvind R Murali
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Abstract
Hepatic granulomas are encountered in approximately 2% to 10% of liver biopsies. There are many potential infectious and noninfectious causes; granulomas can be generally classified by their morphology, which may be helpful in refining the differential diagnosis. This article provides a review of hepatic granulomas with an emphasis on infectious causes.
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Affiliation(s)
- Eun-Young Karen Choi
- Department of Pathology, University of Michigan, University of Michigan, 5231B Medical Science I, 1301 Catherine Street, SPC 5602, Ann Arbor, MI 48109, USA.
| | - Laura W Lamps
- Department of Pathology, University of Michigan, University of Michigan, 5231B Medical Science I, 1301 Catherine Street, SPC 5602, Ann Arbor, MI 48109, USA
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Liver and Bile Duct Infections. DIAGNOSTIC PATHOLOGY OF INFECTIOUS DISEASE 2018. [PMCID: PMC7152297 DOI: 10.1016/b978-0-323-44585-6.00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Dick L, Hannay J. Enterobius vermicularis presentation during laparoscopic cholecystectomy. J Surg Case Rep 2017; 2017:rjw239. [PMID: 28096322 PMCID: PMC5241814 DOI: 10.1093/jscr/rjw239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Enterobius vermicularis infection is uncommon in adults, compared to children, and rarely causes significant illness. Adult infection is usually colonic in nature and found incidentally at colonoscopy. Worm migration to other tissues is rare. We here-in describe the case of a 73-year-old woman found to have biliary tree E. vermicularis—an as yet undescribed site of migration.
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Affiliation(s)
- Lachlan Dick
- Department of Surgery, Inverclyde Royal Hospital, Greenock, UK
| | - Jonathan Hannay
- Department of Surgery, Inverclyde Royal Hospital, Greenock, UK
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Furnée EJB, Spoto C, de Graaf MJ, Smakman N. Enterobius vermicularis infection of the liver in a patient with colorectal carcinoma with suspected liver metastasis. BMJ Case Rep 2015; 2015:bcr-2015-212271. [PMID: 26546623 DOI: 10.1136/bcr-2015-212271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 68-year-old man diagnosed with cT3N2 adenocarcinoma of the rectum presented with a synchronous solitary liver metastasis on CT scan. Neoadjuvant chemoradiotherapy was started to downstage the primary tumour. Resection of the rectal tumour followed 3 months after the last radiotherapy session and primary resection of the isolated liver lesion was performed in the intervening period. Histopathological assessment of the liver lesion, however, showed no malignancy, but did reveal a necrotic infection due to Enterobius vermicularis. This parasite is frequently found in the intestines, but only rarely infects the liver. The patient was subsequently treated with the anthelmintic drug mebendazole 100 mg once a week for 2 weeks. Histopathological assessment of the rectal specimen showed complete regression after neoadjuvant chemoradiotherapy without evidence of remaining E. vermicularis, suggesting pinworm eradication. The patient recovered promptly after both surgical procedures.
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Affiliation(s)
- Edgar J B Furnée
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Clothaire Spoto
- Department of Pathology, Diakonessenhuis, Utrecht, The Netherlands
| | - Melanie J de Graaf
- Department of Clinical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands Department of Clinical Microbiology, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - Niels Smakman
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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Abstract
CONTEXT Many diseases that cause granulomas or granulomatous inflammation involve the liver. Some of these disease processes are intrinsic hepatic diseases, whereas others are disseminated systemic diseases that involve the liver as well as other organs. OBJECTIVE To review the evaluation of granulomas in the liver with an emphasis on infectious causes, as well as the use of special stains, serologic studies, and molecular diagnostic techniques. Pertinent noninfectious causes of hepatic granulomas that are in the differential diagnosis are also discussed. DATA SOURCES Literature review and cases acquired during years of practice. CONCLUSIONS A wide variety of infectious and noninfectious entities cause hepatic granulomas.
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Affiliation(s)
- Laura W Lamps
- From the Department of Pathology, University of Arkansas for Medical Sciences, Little Rock
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Arkoulis N, Zerbinis H, Simatos G, Nisiotis A. Enterobius vermicularis (pinworm) infection of the liver mimicking malignancy: Presentation of a new case and review of current literature. Int J Surg Case Rep 2011; 3:6-9. [PMID: 22288029 DOI: 10.1016/j.ijscr.2011.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 10/01/2011] [Accepted: 10/10/2011] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Enterobius vermicularis or "pinworm" infection of the liver is an extremely rare condition with only five cases previously reported in literature. It is characterized by the presence of granulomas in the liver with a necrotic core, containing adult helminthes or their ova. Because of the relatively mild symptomatology associated with this disease, prior to the arrival of modern imaging methods hepatic enterobiasis was an incidental intra-operative finding during abdominal surgery for other conditions. In recent years however, with high-resolution abdominal imaging readily available and the improved safety of hepatic resection, a lower threshold for treating suspicious hepatic nodules aggressively with surgery is being adopted. PRESENTATION OF CASE We present the second case in international literature, where E. vermicularis of the liver was mistaken for malignancy and led to hepatic resection and perform a literature review of the five previously documented cases of hepatic enterobiasis. DISCUSSION Our report identifies certain trends in this condition's aetiology and clinical behaviour, but due to its rarity definitive answers cannot yet be established. CONCLUSION We do not advocate a change in the current approach of suspicious hepatic nodules, but we do feel that better understanding of the mechanisms involved with hepatic enterobiasis could, in the future, prevent unnecessary surgery.
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Affiliation(s)
- Nikolaos Arkoulis
- Department of Plastic Surgery, St. John's Hospital, Livingston, Scotland EH54 6PP, UK
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Day S. Threadworm: an infrequent clinical finding in a genitourinary medicine clinic attendee presenting with ano-genital irritation. Int J STD AIDS 2009; 20:362-3. [PMID: 19386978 DOI: 10.1258/ijsa.2009.008507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 24-year-old lady presented to an evening genitourinary (GU) clinic with a short history of vulval and anal irritation. On perianal examination, several threadworms were visible. Symptoms resolved with oral mebendazole and strict personal and environmental hygiene. Threadworm is a common and easily treatable cause of pruritis ani, yet is underreported in GU literature. If the history is suggestive, consider performing the diagnostic cellophane test and/or prescribing empirical treatment.
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Affiliation(s)
- S Day
- St Stephen's Centre, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
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Abstract
Granulomas are aggregates of macrophages, often admixed with other inflammatory cells, which usually result from chronic antigen presentation. Many diseases that produce granulomas involve the liver. Some are intrinsic hepatic diseases, whereas others are disseminated systemic diseases that involve the liver and other organs. Hepatic granulomas are reportedly present in 2% to 10% of all liver biopsy specimens examined in general practice, and of those supposedly as many as 36% have no discoverable etiology even after extensive evaluation of the specimen. This review focuses on the diagnosis of granulomas in infectious diseases affecting the liver, including use of special stains, serologic studies, and molecular diagnostic techniques, and discusses pertinent noninfectious causes of hepatic granulomas that are in the differential diagnosis.
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Petro M, Iavu K, Minocha A. Unusual endoscopic and microscopic view of Enterobius vermicularis: a case report with a review of the literature. South Med J 2005; 98:927-9. [PMID: 16217987 DOI: 10.1097/01.smj.0000163347.53138.b1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Enterobius vermicularis has the broadest geographic range of any helminth and is the most common intestinal parasite seen in the primary care setting. Underappreciated is the fact that it is not always a benign disorder and could even cause life-threatening medical problems. Visualization of the actual worms during endoscopy is probably underappreciated in part because endoscopists have never actually seen the worm and/or are not actively looking for, or anticipating, worms. This report describes a case of worm infection as documented during colonoscopy and confirmed by microscopy. The gross and microscopic appearance of the worm is described. Literature regarding the wide range of gastrointestinal and nongastrointestinal manifestations, including potentially life-threatening illnesses, as well as treatment options, are also reviewed.
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Affiliation(s)
- Michelle Petro
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Nithikathkul C, Akarachantachote N, Wannapinyosheep S, Pumdonming W, Brodsky M, Sukthana Y. Impact of health educational programmes on the prevalence of enterobiasis in schoolchildren in Thailand. J Helminthol 2005; 79:61-5. [PMID: 15831115 DOI: 10.1079/joh2004272] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Enterobiasis is a worldwide prevalent disease particularly in low income areas. The budget needed for the prevention, treatment and eradication of the disease has thus far frustrated the limited budgets of global public health systems. A study was undertaken to determine if education in addition to medical treatment of enterobiasis could make a difference to the rates of infection. A total of 777 children (399 male and 378 female) from 11 elementary schools in five districts of Samut Prakan Province, Thailand were examined between December 2000 and March 2002. In five of the 11 schools studied, medical treatments were applied, followed by a programme of educating the children in the prevention of infection. Children in the remaining six schools received medical treatment only. The study showed a decrease in infections among children who received supplementary education. This decrease was significant in comparison to the decrease shown among children who received medical treatment only. The study therefore showed that educating high risk individuals played a key role in the prevention of enterobiasis.
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Affiliation(s)
- C Nithikathkul
- Department of Biological Science, Faculty of Science and Technology, Huachiew Chalermprakiet University, Samut Prakan Province, Thailand.
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Ng WSW, Gallagher J, McCaughan G. "Pinworm" infection of the liver: unusual CT appearance leading to hepatic resection. Dig Dis Sci 2004; 49:466-8. [PMID: 15139500 DOI: 10.1023/b:ddas.0000020505.46611.a0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Wa Sang Watson Ng
- The A. W. Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Missenden Road, Camperdown, NSW 2050, Australia
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Santos VMD, Silva MBDO, Bernardes JMG, Lima MAD. [Granulomatous nodule with Enterobius vermicularis in epiploon simulating metastasis of ovarian cancer]. Rev Soc Bras Med Trop 2002; 35:191-3. [PMID: 12011929 DOI: 10.1590/s0037-86822002000200010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors describe a case of peritoneal enterobiasis presenting as necrotizing granuloma, in a adolescent with tumor of the ovarian endodermic sinus. The diagnosis was established through biopsy of peritoneal nodule, during laparotomy for staging system of ovarian cancer. Granulomatous nodules due to parasites could simulate metastasis, and cause confusion in the staging system for cancer.
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Abstract
Enterobius vermicularis (syn. Oxyurus vermicularis), also known as pinworm or seatworm, is the causative agent of human enterobiasis (oxyuriasis). The disease is more prevalent in temperate regions and is facilitated by factors such as overcrowding in schools and family groupings, as well as inadequate personal and community hygiene. Although the infection is more likely to occur in lower socioeconomic groups, enterobiasis has been reported to affect virtually every level of the general population and especially children. In the great majority of cases, enterobiasis is asymptomatic. One common symptom is intense pruritus ani that in some patients can lead to insomnia, restlessness and irritability. Scratching may cause skin irritation, and in more serious cases, eczematous dermatitis, haemorrhage or secondary bacterial infections. Ectopic migration of E. vermicularis often results in pinworm infestation of the female genital tract often causing granulomas of the uterus, ovary and the fallopian tubes and pelvic peritoneum. Anthelmintic therapies for enterobiasis are successful and include mebendazole, albendazole and pyrantel pamoate. Mass medication of affected groups reduced symptoms rapidly, progressively and in a cost-effective way.
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Affiliation(s)
- V St Georgiev
- National Institute of Allergy and Infectious, Disease, NIH, 6700-B Rockledge Drive, Room 2102, Bethesda, Maryland 20892, USA.
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Avolio L, Avoltini V, Ceffa F, Bragheri R. Perianal granuloma caused by Enterobius vermicularis: report of a new observation and review of the literature. J Pediatr 1998; 132:1055-6. [PMID: 9627606 DOI: 10.1016/s0022-3476(98)70411-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The literature reports 12 cases of enterobiasis presenting as perianal abscess or granuloma. We describe an additional case of a perianal granuloma containing Enterobius vermicularis eggs in a 5-year-old boy. We suggest routine parasite screening for all children presenting with this condition.
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Affiliation(s)
- L Avolio
- Divisione di Chirurgia Pediatrica, IRCCS Policlinico San Matteo, Pavia, Italy
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Abstract
Enterobius vermicularis ('pinworm') is rarely found outside the gastro-intestinal tract. We describe a case of extra-intestinal pinworm abscess associated with an inguinal hernia in an adult. A brief review of the literature is given and possible mechanisms of tissue invasion are discussed.
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Affiliation(s)
- N G Tornieporth
- Second Department of Internal Medicine, Technical University of Munich, Germany
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Affiliation(s)
- S P Goldenberg
- Department of Medicine, Griffin Hospital, Yale University School of Medicine, Derby, Connecticut 06418
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