December 1994, Volume 44, Issue 12

Letter to the Editor

Coincidence of Acute Amoebic Appendicitis and Enterobius Vermicularis Infestation

Dear Madam, We would like to share our experience with reference to the article ‘Amoebic Appendicitis - a rare entity’ by Ahmed et al., published in April, 1994, Vol. 44: No.4, pp.92-93 issue. This is an extremely unusual case report of acute amoebic appendicitis with simultaneous occurrence of enterobius vermicularis in the appendiceal lumen. Enterobius vermicularis rarely causes serious lesions in man. Most lesions are limited to gastrointestinal tract and include minute ulcers and mild mucosal inflammation of the intestine. Occasionally invasion of superficial mucosa occurs which elicits a granulomatous reaction1. Adult worms are commonly seen in the lumen of the appendix and approxi­mately 3% appendices submitted for histopathological exami­nation have shown parasitic infestation2 . The pinworms are not the causal agent for acute appendicitis, however, some believe that it can cause inflammation or may produce symptoms resembling acute appendicitis3,4 Entamoeba histolytica as a cause of acute appendicitis, either primary or secondary to colonic infection, is rare but well recognized. Coincidence of these two parasitic infesta­tions in appendix has not been described in the literature, however, in one series, the coincidence of pinworm and Dientamoeba fragilis organisms have been described4. In our case the histopathological examination of appendix revealed mucosal ulceration, inflammatory exudate and many amoebic tmphozoites some of which contain phagocytosed red cells. Characteristic flask shaped mucosal ulcer containing amoebic trophozoite was also seen (Figure 1).

Adult worms of enterobius vermicularis in the appendiceal lumen surrounded by inflammatory exudate were identified in the same appendix (Figure 2).

Suhail Muzaffar, Naila Kayani and Sheema H. Hasan
Department of Pathology, The Aga Khan University Hospital, Karachi.


1. Binfor, C.H. and Counor, D.H. PathoJogy of tropical and extra- ordinary diseases. Armed Forces Institute of Pathology, Washington, DC., Universities associated for research and education in pathology Inc., 1976 pp. 456-57.
2. Dalimi, A. andKhoshzabsn, E Coruparativestudy oftwomethodsforthediagnosis of enterobius vermicularis in the appendix. J.Helminthol., 1993;67:85-86.
3. Wiebe, B.M. Appendicitis and enterobius vermicularis. Scand.J.Gastroenterol., 1991 ;26:336-38.
4. Cerva, L., Schrottenbaum, M. and Kliment, V. Intestinalparasites: a study ofhuman appendices. Folis. Parasitol. (Praha), 1991 ;38:5-9.

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