Title : Acute pancreatitis induced by ascaris lumbricoides in the context of acute viral hepatitis A – literature review and clinical insights
Abstract:
Background: Ascaris lumbricoides is the most common helminthic infection worldwide. Its migration into the biliary or pancreatic ducts can lead to serious complications, such as acute pancreatitis. Coinfection with hepatitis A virus (HAV) may exacerbate inflammation and increase the risk of pancreatic involvement, particularly in children.
Objective: To review the literature regarding acute pancreatitis triggered by Ascaris lumbricoides in HAV-infected patients and to illustrate this rare clinical association through a complex pediatric case.
Method: A systematic search was performed in PubMed, Web of Science, and Google Scholar using the keywords: “pancreatitis”, “ascaris”, “hepatitis A”, “co-infection”, “acute liver disease”. Inclusion criteria: confirmed acute pancreatitis, positive HAV IgM serology and documented Ascaris presence. Additionally, a detailed clinical case is presented.
Results: Four literature cases met inclusion criteria. We report the case of a 7-year-old boy admitted with severe HAV infection (from a rural and within-family outbreak of acute viral hepatitis, with two more brothers infected with Ascaris and hepatitis), who developed acute necrotic-hemorrhagic pancreatitis following vomiting of a 7 live Ascaris. Imaging (ultrasound and CT) confirmed pancreatic necrosis and peritoneal fluid collections. Surgical drainage and debridement were performed. A residual pancreatic fistula was endoscopically treated in Bambino Gesu Hospital in Rome, Italy. The patient recovered after antiparasitic therapy (introduced after improvement of liver function), targeted antibiotics and intensive supportive care.
Conclusion: This rare triad (Ascaris infestation, HAV infection and acute pancreatitis) requires high clinical suspicion, especially in endemic areas. Early imaging, prompt antiparasitic treatment, and multidisciplinary management can significantly improve prognosis and reduce complications.
