Enterobius vermicularis in the Endometrium of the Uterus

Enterobius vermicularis is an intestinal nematode of humans and the most common helminth infection. Main transmission path is direct contact between infected and uninfected person meaning ingestion of the eggs. Human infections are usually asymptomatic or manifest as perianal itching. Although ectopic locations are uncommon, Enterobius can occasionally be detected in appendix, kidney, male urinary tract and female genital tract. We present a case from Varaždin General Hospital, Varaždin, Croatia in 2012, involving a 90-yr-old female patient who underwent hysterectomy leading to accidental finding of E. vermicularis in the uterus despite being asymptomatic for enterobiasis. Since there were no signs and symptoms of parasitic infection, no antiparasitic drugs were administered. Parasite was not observed during macroscopic examination, yet microscopic examination of the material demonstrated helminth within endometrium surrounded by dense inflammatory infiltrate, predominantly lymphocytes and some eosinophils. Internal structures of the parasite were collapsed, while well-developed musculature and cuticle were preserved. We present this case to educate and remind physicians on this parasitosis as possible diagnosis. Although non-gastrointestinal locations of Enterobius infestation are rare, this infection should be considered in patients with abdominal pain, genitourinary symptoms, and pelvic pain in order to apply appropriate treatment and prevent further complications.