Stomach-churning cause of man’s fever and pain

Doctors have found the stomach-churning reason behind a man’s fever and abdominal pain.

The 68-year-old Thai man had two days of fever, abdominal pain and jaundice, according to his case in the British Medical Journal Case Reports.

The man also reported nausea and vomiting for 12 months.

His symptoms had doctors believing he might have choledocholithiasis or a type of bile duct obstruction caused by gallstones.

Doctors performed an ultrasound and found “a tubular-shaped hypoechoic lesion filling in the common bile duct” and one in the left hepatic bile duct.

Ultrasonography of hepatobiliary showing a tubular-shaped hypoechoic lesion filling in a common bile duct and a left hepatic bile duct.
The ultrasound reveals something 'tubular' in the man's bile. Source: British Medical Journal Case Reports

The man underwent endoscopic retrograde cholangiography which is used to determine issues in the bile duct.

“The findings revealed multiple, creamy-coloured roundworms coming out from the ampulla of Vater, and the second part of the duodenum,” researchers wrote.

“He was diagnosed with acute cholangitis from hepatobiliary ascariasis.”

Acute cholangitis is a bacterial infection causing the obstruction of the bile duct.

But in this man’s case his was “unusual”, doctors noted, given it was caused by parasitic worms.

Ascaris worms are pictured after being removed from a man, 68.
Some of the ascaris worms removed from the man. Source: British Medical Journal Case Reports

Doctors remove parasitic worms

Acute cholangitis caused by parasites is “a rare entity” “nowadays”, doctors wrote.

Doctors performed endoscopic removal of the ascaris worms. He was also given medication to evacuate the rest of the worms over a 14-day period. A photo provided in the study shows he had at least five worms.

On follow-up after this he was fine with his fever gone along with the abdominal pain.

“Ascaris is one of the parasites that can cause biliary obstruction and linked to biliary sepsis,” researchers wrote.

“To our knowledge, ascariasis is common in both tropical and low-income and middle-income countries, where they are perpetuated by untreated sewage used as a fertiliser and flowing into rivers and lakes.”

It is not clear how the man came to be infected by the parasites.

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