Case 44.  Ascaris lumbricoides-induced liver abscess (57 y-o F)
         
   
Surgically resected liver with multicystic lesions at the liver hilus
   
         
   
Key words :  Ascaris lumbricoides, liver abscess
   
     
 
     
The fused abscess walls are lined by xanthogranuloma, and separated by densely fibrous tissue (gross findings).   The abscess wall is totally encapsulated, and filled with necrotic exudates (HE, low power). No adult worm is discernible.
     
 
     
In the necrotic exudate, a few calcified ova measuring 70-80 μm are discerned, in association with deposition of eosinophilic (Charcot-Leiden's) crystals (HE, high power).   The 1:500 diluted patient's own serum is specifically reactive with the ova (indirect immunoperoxidase).
     
 
     
Ouchterlony analysis of the patient's serum for serological diagnosis of ascariasis, using the extract of helminth
As: Ascaris lumbricoides, Em: Ecchinococcus multilocularis, Fh: Fasciola hepatica, Tc: Toxocara canis, Ev: Enterobius vermicularis, CRP: anti-C-reactive protein. The patient's serum form a precipitation line only with Ascaris extract (left half). The precipitation line disappears after preabsorption of the serum with the Ascaris extract (right half).
  Reference case 44A
A round worm coming across upon endoscopic examination (45 y-o M). The endoscopist failed to trace the worm, because of its quick movement.
     
   
     
Reference case 44A
A dead adult of Ascaris lumbricoides, excreted after anti-parasite drug (Gastrographin) administration. Only one female adult was excreted (Oh! Pitiful lady worm). The patient ate imported Kimuchi (Korean pickled cabbage), which may be contaminated with Ascaris ova.