Ascaris Lumbricoides through an Intercostal Chest Tube in A Case with Hodgkin's Lymphoma

Ascaris lumbricoides typically mimics pneumonia during its larval migration phase. However, its presentation with pleural effusion and the recovery of a live adult worm through an intercostal chest tube is extraordinarily rare. This case highlights a unique opportunistic parasitic infection in an immunocompromised paediatric patient, emphasising the need to consider parasitic aetiologies in refractory pulmonary symptoms within oncology settings.

A 15-year-old female with stage IIIA Hodgkin's lymphoma presented with fever, cough and respiratory distress five days after completing her second cycle of COPDAC chemotherapy. Despite broad-spectrum antibiotics and bilateral chest tube insertion for persistent pleural effusion, her clinical condition remained refractory. A live, 15-cm adult A. lumbricoides was unexpectedly recovered from the right chest tube. Following a 21-day course of albendazole, the patient showed complete clinical and radiological resolution.

In paediatric oncology patients, standard treatments for pneumonia may fail when atypical pathogens are involved. This case underscores that clinicians should maintain a high index of suspicion for helminthic infections in immunocompromised hosts presenting with atypical or refractory pleural and pulmonary findings.

Atypical parasitic presentation Clinicians should consider parasitic aetiologies, such as Ascaris lumbricoides, in immunocompromised paediatric oncology patients presenting with refractory pneumonia and severe pleural effusion that do not respond to standard antimicrobial therapies.Chemotherapy-induced vulnerability Severe immunosuppression and corticosteroid use associated with lymphoma protocols can alter standard biological barriers, facilitating aberrant migration pathways for helminths into the pleural cavity.Diagnostic vigilance The unexpected extraction of a live adult worm from an intercostal chest tube emphasises the critical need for comprehensive screening and high clinical suspicion for atypical pathogens in endemic regions.