A 69-year-old female patient, who underwent liver transplantation for cirrhosis and hepatocellular carcinoma, developed a severe atypical infectious complication in the postoperative period. With a history of treated hepatitis C and type 2 diabetes mellitus, she underwent liver transplant in April 2025, initially evolving favorably and being discharged after 7 days. However, she was readmitted emergently one day after discharge with acute abdomen due to perforation. Exploratory laparotomy revealed a perforation in the terminal ileum, initially suspected to be of viral etiology such as cytomegalovirus (CMV), and required partial colectomy and terminal ileostomy. In the postoperative period of the reoperation, during ileostomy manipulation, elimination of multiple adult parasites compatible with Ascaris lumbricoides was observed. Stool parasitology was requested, and specific treatment with ivermectin was promptly initiated. This case illustrates the diagnostic and therapeutic challenges of opportunistic infections in immunocompromised solid organ transplant recipients. Intestinal perforation in transplant patients is a severe complication, and helminths such as Ascaris lumbricoides should be considered in the differential diagnosis, especially in patients from areas endemic for parasitic diseases. Immunosuppression, essential for graft survival, may favor atypical manifestations or increased severity of latent infections. The incidental detection of parasites underscores the importance of high clinical suspicion and inclusion of parasitological screening in pre-transplant protocols, as well as active surveillance for unusual presentations of infections in the post-transplant period, aiming to improve patient safety and optimize clinical outcomes.
Gurgel et al. (Sun,) studied this question.