Enterobius vermicularis: Coming Soon to an Appendix Near You?

In underdeveloped countries, Enterobius vermicularis is one of the most prevalent parasitic infections of the gastrointestinal tract. E. vermicularis' presence within the appendix has been shown to cause symptoms that mirror classic appendicitis but frequently does not have any histological evidence of acute inflammation. Although not an unprecedented finding in developing countries, literature rarely examines the incidence in Western countries. This report presents the case of a nine-year-old adolescent girl from the Midwestern United States who showed evidence of E. vermicularis within an appendectomy specimen. She presented with a four-day history of abdominal pain. Laboratory values were consistent with elevated infectious markers for a parasite infection, and radiologic findings suggested acute appendicitis. However, histopathology revealed a benign appendix with intraluminal parasitic worms most consistent with E. vermicularis. This case serves as a reminder that, although it is more common to find evidence of E. vermicularis within appendectomy specimens in developing countries, it cannot be completely ruled out in developed countries also, especially in rural settings and low-resourced environments.