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

BACKGROUND: 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. CONCLUSIONS: 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.