Worm in the Water: Diagnosing Urinary Ascariasis in an Elderly Patient Through Routine Microscopy

Ascariasis is primarily an intestinal parasitic infection, with ectopic migration to the genitourinary tract, representing an uncommon clinical entity. Such presentations are infrequently reported and may pose a diagnostic challenge, particularly in the absence of gastrointestinal symptoms. We report a case of an 88-year-old female from a suburban region of Nepal, who presented with bilateral iliac pain and dysuria of three days' duration. Physical examination was notable for mild lower abdominal tenderness, with stable hemodynamic parameters. Laboratory investigations revealed leukocytosis with neutrophilic predominance. Urine microscopy demonstrated the presence of a motile helminth, subsequently identified as Ascaris lumbricoides. The patient denied gastrointestinal complaints, fever, or any prior history suggestive of helminthic infection. This case illustrates a rare presentation of urinary ascariasis diagnosed through conventional urine microscopy in the absence of gastrointestinal manifestations. The diagnosis was established using basic diagnostic modalities available in a suburban healthcare setting, underscoring the continued relevance of routine microscopy in detecting atypical parasitic infections. Although rare, urinary ascariasis should remain a differential consideration in patients from endemic areas presenting with urinary tract symptoms. In resource-limited settings, fundamental laboratory techniques continue to play a critical role in identifying uncommon infectious etiologies.