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01.12.2017 | Case report | Ausgabe 1/2017 Open Access

International Journal of Emergency Medicine 1/2017

Ascariasis and hyperosmolar hyperglycemic state: a surprising ultrasound finding in the emergency department

International Journal of Emergency Medicine > Ausgabe 1/2017
Giles N. Cattermole, Jean-Paul Nzabandora
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Electronic supplementary material

The online version of this article (doi:10.​1186/​s12245-017-0138-7) contains supplementary material, which is available to authorized users.



We report the ultrasound finding of ascariasis in a patient with hyperosmolar hyperglycemic state (HHS). Although ascariasis is common in low-resource settings, there has been no previous report associating ascariasis with HHS.

Case presentation

A 26-year-old Rwandan man was admitted to the emergency department in coma, with a glycemia of 600 mg/dl. He was resuscitated with fluids, intubated and ventilated, and treated with insulin and antibiotics. On day 3, an ascaris worm was passed via his nasogastric tube, and abdominal ultrasound revealed a heavy worm load. He was treated with albendazole and eventually made a full recovery.


This is the first report of ascariasis as a potential cause of HHS, and we recommend that emergency practitioners consider early abdominal ultrasound in patients with hyperglycemic emergencies in areas with a high prevalence of ascariasis.
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