Worm Passing from the Mouth

An 18-year-old Rohingya woman, who was pregnant at 21 weeks, was admitted with a complaint of epigastric pain and nausea for two days. She is a Burmese refugee who has been in Malaysia for two years. She had previously eaten undercooked meat. Systematic examination was unremarkable. She was given intravenous fluids and symptomatic treatment, which included antacids and anti-emetics. She had one bout of vomiting in the ward and expelled a roundworm from her mouth. The worm was approximately 20 cm in length, and 5 mm in diameter, and it appeared elongated, cylindrical, and tapered at both ends (Figure 1). The worm was identified as an adult female Ascaris lumbricoides. Microscopic examination of the stool sample revealed the presence of fertilized eggs that are oval-shaped and surrounded by thick mammillated outer shell (Figure 2). She did not have intestinal obstruction, biliary ascariasis, or peripheral eosinophilia. She was given a single dose of albendazole 400 mg and was advised on proper food hygiene and sanitation.