Bronchial mucus plug mimicking fragmented Ascaris worm: An ambiguous case presentation

With increasing travel and immunosuppression, parasitic lung and pleural diseases are increasingly been reported. The diagnosis in certain cases is very challenging because of nonspecific clinical and radiological features. We hereby present a case of a 60-year-old immunocompetent female complaining of difficulty in breathing for 4–5 days for which sputum sample along with the coughed-up fragment of the parasite under investigation was sent to the laboratory. All the blood parameters along with blood and sputum culture were within normal limits. Direct microscopy for sputum and multiple fecal samples did not yield any significant information. Chest X-ray was normal, whereas contrast-enhanced computed tomography scan changes were suggestive of fibrotic changes and mucoid impaction. The histopathological examination showed thick mucus content and no evidence of a parasitic infestation, worm, larva, or ova. So the differential diagnosis of the right lower lobe obstruction probably due to mucus plug was made, and the patient was referred to a pulmonologist for further follow-up. This case highlights the importance of common respiratory disorders characterized by mucus plugs and that some may mimic parasitic segments. Specific clinical, radiological, and pathologic features, microscopic examination, or serological testing can help to narrow the differential diagnosis of infective or noninfective causes and help the patients in early and accurate diagnosis and treatment and save them from unnecessary expensive and invasive investigations.