Pulmonary ascariasis in a child with tuberculosis: a case report on Ascaris lumbricoides draining via pleural fluid

We present a single case of a 10-year-old female with co-infection of pulmonary tuberculosis and pulmonary ascariasis from the Amhara region of Ethiopia, highlighting the rare migration of Ascaris lumbricoides from the gastrointestinal tract to the respiratory system. This case adds to the scientific literature by emphasizing the potential for coexisting infections, particularly in regions where both tuberculosis and parasitic infections are endemic, such as Ethiopia. The patient presented with abdominal pain, productive cough with yellowish sputum, shortness of breath, weight loss, and night sweats. Initially diagnosed with pneumonia complicated by parapneumonic effusion, she exhibited no improvement despite antibiotic treatment. A presumptive diagnosis of tuberculosis was made, prompting the initiation of antibiotics alongside anti-tuberculosis medications and chest tube drainage. During the management of her condition, an Ascaris lumbricoides worm was unexpectedly found in the pleural fluid, leading to a confirmed diagnosis of pulmonary ascariasis. The discovery of the Ascaris worm necessitated adjustments in treatment protocols, highlighting the complexity of managing co-infections in this patient. This case underscores the importance of comprehensive diagnostic evaluations in pediatric patients presenting with respiratory symptoms, particularly in endemic regions. This case underscores the importance of maintaining a broad differential diagnosis in pediatric patients with respiratory symptoms, especially in endemic regions where co-infections are common. It also highlights the need for integrating parasitological evaluations into the diagnostic process to ensure timely and accurate diagnosis.