2699 An Uncommon Cause of Vomiting and Abdominal Pain in Pregnancy

Abstract

INTRODUCTION: Anisakis is a zoonotic parasitic disease that infects marine mammals. Gastrointestinal anisakiasis is caused by consumption of undercooked or raw seafood infected by nematodes of the Anisakis species. While it is common in Asia it is an uncommon infection in North America with only a few reported cases. Here we present a case of gastric anisakiasis in a pregnant woman complicating the diagnosis and management. CASE DESCRIPTION/METHODS: A 32 year old newly pregnant female presented to the infectious disease clinic with acute onset abdominal pain and emesis. She reported finding two mobile “worms” in raw salmon, after ingesting six ounces of the fish, a day before. A specimen was sent to the microbiology laboratory with the preliminary read concerning for roundworm. Given the concern for anisakiasis, pregnancy status and risk of perforation, she was directly admitted for upper endoscopy. This revealed a thin, translucent, 20 mm × 1 mm worm burrowed into the greater curvature of the proximal antrum. The worm was removed in entirety with cold biopsy forceps and sent to microbiology. Biopsies were taken from the site of burrow. Pathology was consistent with mild gastritis with focally increased eosinophils and no remnant of the parasite. The worm was identified as anisakis species. The patient’s symptoms resolved spontaneously. Her pregnancy limited evaluation of the remainder of her G.I tract for evidence of infection. Since she had no symptoms of obstruction, she was discharged with instructions to complete a bowel purge upon returning home. DISCUSSION: Gastric anisakiasis is uncommon in the U.S. In addition, this case was complicated by the patient’s pregnancy, precluding the use of imaging techniques such as CT scans to help narrow the diagnosis in suspected anisakiasis and exonerate complications. Obstruction is a commonly reported complication for which there has been reported success with Albendazole therapy, undesirable in this case, being pregnancy category C. Another reported and somber complication includes perforation from the burrowing of untreated parasites. To minimize adverse outcomes with imaging and antiparasitic therapy, our patient underwent curative endoscopic therapy followed by a bowel purge to empirically purge remaining parasites from the distal G.I tract. With globalization of cuisine and increasing consumption of raw fish in the west, physicians should have a heightened suspicion of parasitic infections such as anisakis given the significant sequalae of untreated infection.