Ascaris lumbricoides is a globally prevalent helminth that can cause hepatobiliary, pancreatic, and pulmonary complications. In immunocompetent individuals, parasitic migration typically provokes marked eosinophilia. However, underlying hematologic malignancies can blunt expected immune responses and obscure early clinical recognition. We report a case involving a 23-year-old female with a new diagnosis of Burkitt lymphoma who presented with severe epigastric pain, obstructive jaundice, and laboratory findings consistent with cholangitis and pancreatitis. Despite biliary drainage and broad-spectrum antibiotics, her condition worsened, with progressive cytopenias, renal failure, and hypoxemia. Chest CT demonstrated a “head cheese” pattern consistent with hypersensitivity pneumonitis. She subsequently expelled a 15 cm Ascaris lumbricoides worm, and stool examination confirmed a heavy infestation. Despite antiparasitic therapy, she developed refractory septic shock and ultimately died. This report underscores an atypical and fatal multisystem presentation of Ascaris infection in the setting of Burkitt lymphoma. Immunosuppression masked classical parasitic indicators, emphasizing the importance of maintaining clinical suspicion for helminthic disease in endemic regions.
Fernandez et al. (Fri,) studied this question.