Intestinal Perforation Due to Adult Tapeworm of Taenia: A Case Report and Review of the Literature.

Taeniasis is an intestinal helminth infection due to adult tapeworms belonging to the genus Taenia. Taeniasis remains a major burden in low-income countries in Asia. We present a case of intestinal perforation caused by adult tapeworm of Taenia in a 50-year-old Nepali male. The patients presented to the hospital with severe abdominal pain and intermittent vomiting. Following clinical presentations and imaging features, gastrointestinal perforation was suspected. Surgical removal of adult tapeworm of Taenia, suspected to be T. saginata or T. asiatica, was carried out during exploratory laparotomy, which was followed by an uneventful postoperative period. In addition to case presentation, we systematically review published case reports on taeniasis-related intestinal perforation. A learning point from this case is clinician should maintain a clinical suspicion of taeniasis as a possible cause of intestinal perforation in endemic areas.

Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives.

Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey's sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein-Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein-Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation.