An unusual cause of pancreatitis in a 46-year-old returning traveller

A 46-year-old previously fit and well man, travelled to Jhelum, Pakistan for 6 weeks in early 2015. Four weeks after returning to the UK, he developed sudden onset epigastric pain, vomiting and fever. C reactive protein was 232 mg/L and amylase was 2061 U/L. He was treated conservatively as pancreatitis, with peripancreatic streaking and left colic gutter fluid on a CT abdominal scan. He was discharged and later attended the Hospital for Tropical Diseases, after coughing up an 8 cm male ascaris worm. He was treated for acute ascariasis infection, complicated by resolved mild-moderate pancreatitis, a common complication in the developing world but rarely seen among travellers.