An Unusual Case of Epistaxis: Intranasal <i>Bipalium</i> Pseudoparasite

Hammerhead worms are becoming increasingly common in the southeastern United States as the invasive species continues to spread. Limited data exist on this species acting as a pseudoparasite, with only 3 documented cases found on literature review of Bipalidae species living inside human hosts. We present one such case from Shreveport, Louisiana, of a patient who arrived at the emergency department after a hammerhead worm was expelled from his sinus passage. A 13-y-old male with a history of autism and developmental delay had been complaining of headache for 2 to 3 d. He had a spontaneous nosebleed from his right nostril on the morning of presentation to the emergency department. On blowing his nose, a large hammerhead worm was evacuated from his sinuses. Imaging studies and direct visualization did not reveal any significant damage or remaining helminths in the sinus passages. Due to patient risk factors for parasitic infection, while definitive identification of the worm species was still pending, a course of albendazole was prescribed. The patient was discharged from the emergency department in good condition. As this invasive species becomes more common in warm and humid areas of the United States, infection with these pseudoparasites may become more prevalent as well. Fortunately, this appears to be a rare occurrence, and clinical sequelae appear to be minimal after removal of the organism.